Healthcare Provider Details

I. General information

NPI: 1952719650
Provider Name (Legal Business Name): RENEE LEE BRUNNER -HOUSER MSN, PMHNP-BC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2014
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1858 W 5150 S
ROY UT
84067-3000
US

IV. Provider business mailing address

6013 S REDWOOD RD
TAYLORSVILLE UT
84123-5220
US

V. Phone/Fax

Practice location:
  • Phone: 801-255-5131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number13904086-4405
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number13904086-8900
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC-APN.0001441-C-NP
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberAPRN11017321
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number114077
License Number StateNE
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG46689
License Number StateWY
# 7
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number71753
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: