Healthcare Provider Details

I. General information

NPI: 1740280726
Provider Name (Legal Business Name): LISA JULIE RENNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 S MONROE ST SUITE 250
DENVER CO
80209-3705
US

IV. Provider business mailing address

360 S MONROE ST SUITE 250
DENVER CO
80209-3705
US

V. Phone/Fax

Practice location:
  • Phone: 303-333-1232
  • Fax: 303-333-2575
Mailing address:
  • Phone: 303-333-1232
  • Fax: 303-333-2575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number33586
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number33586
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: