MEDICARE: RENEE LEE BRUNNER -HOUSER MSN, PMHNP-BC, RN

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	C-APN.0001441-C-NP	CO
2	2084P0800X	Psychiatry Physician	APRN11017321	FL
3	2084P0800X	Psychiatry Physician	114077	NE
4	2084P0800X	Psychiatry Physician	G46689	WY
5	2084P0800X	Psychiatry Physician	71753	ID
6	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	13904086-4405	UT
7	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	13904086-8900	UT

NPI Number	:	1952719650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE LEE BRUNNER -HOUSER MSN, PMHNP-BC, RN

Provider Business Mailing Address
First Line	:	6013 S REDWOOD RD
Second Line	:
City	:	TAYLORSVILLE
State	:	UT
Zip	:	84123-5220
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1858 W 5150 S
Second Line	:
City	:	ROY
State	:	UT
Zip	:	84067-3000
Country	:	US
Telephone Number	:	801-255-5131
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2014
Last Update Date	:	03/18/2025

LOTE 18 METRO OFFICE PARK , 3RD FLOOR SUITE 3000 AMERICAN HEALTH MEDICARE BUILDING
GUAYNABO, PR
00968

Practice Phone: 787-620-1919
Practice Fax: 787-620-0570

1858 W 5150 S
ROY, UT
84067-3000