Provider Demographics
NPI:1952719650
Name:BRUNNER -HOUSER, RENEE LEE (MSN, PMHNP-BC, RN)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:LEE
Last Name:BRUNNER -HOUSER
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:971 FIR AVE
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-2828
Mailing Address - Country:US
Mailing Address - Phone:720-450-7684
Mailing Address - Fax:
Practice Address - Street 1:50 W BROADWAY STE 300
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-2044
Practice Address - Country:US
Practice Address - Phone:720-450-7684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT139040862084P0800X
IAG146522363LP0808X
AZAP10549363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry