Healthcare Provider Details

I. General information

NPI: 1235742016
Provider Name (Legal Business Name): LUZ ELENA RENI DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5063 S COTTONWOOD ST
MURRAY UT
84107-6766
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-1800
  • Fax: 801-507-1825
Mailing address:
  • Phone:
  • Fax: 801-746-0420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number8044184-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: