Healthcare Provider Details

I. General information

NPI: 1346018330
Provider Name (Legal Business Name): FUSELIER HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2023
Last Update Date: 12/19/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 EAST BRIDGE ST.
BREAUX BRIDGE LA
70517
US

IV. Provider business mailing address

1525 EAST BRIDGE ST.
BREAUX BRIDGE LA
70517
US

V. Phone/Fax

Practice location:
  • Phone: 337-442-1131
  • Fax: 337-442-1223
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: WENDY C. FUSELIER
Title or Position: CO-OWNER/PA
Credential: PA-C
Phone: 337-442-1131