Healthcare Provider Details

I. General information

NPI: 1396343422
Provider Name (Legal Business Name): RENEE YVONNE FRIESNER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RENEE YVONNE FRIESNER PMHNP-BC

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2433 MARCONI AVE
SACRAMENTO CA
95821-4807
US

IV. Provider business mailing address

2433 MARCONI AVE
SACRAMENTO CA
95821-4807
US

V. Phone/Fax

Practice location:
  • Phone: 916-737-5555
  • Fax:
Mailing address:
  • Phone: 916-737-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95209739
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP95016286
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95209739
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95209739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: