Individual
SUSAN RENE' RENELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
750 N 200 W, PROVO, UT 84601-1677
(801) 373-4760
Mailing address
750 N 200 W, PROVO, UT 84601-1677
(801) 373-4760
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
207556-3102
UT
Other
Enumeration date
04/15/2009
Last updated
04/15/2009
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