Healthcare Provider Details

I. General information

NPI: 1417052358
Provider Name (Legal Business Name): CREATIVE IMAGES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4016 RAINTREE RD SUITE 120A
CHESAPEAKE VA
23321
US

IV. Provider business mailing address

4016 RAINTREE RD SUITE 120A
CHESAPEAKE VA
23321-3700
US

V. Phone/Fax

Practice location:
  • Phone: 757-398-9101
  • Fax: 757-398-9102
Mailing address:
  • Phone: 757-398-9101
  • Fax: 757-398-9102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. LASHONDA DENENE RAMSEY
Title or Position: OWNER
Credential: CFM
Phone: 757-398-9101