Healthcare Provider Details

I. General information

NPI: 1336542992
Provider Name (Legal Business Name): FUSION HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2014
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 W PIERCE ST STE 6G STE 6G
CARLSBAD NM
88220-3566
US

IV. Provider business mailing address

2402 W PIERCE ST STE 6G STE 6G
CARLSBAD NM
88220-3566
US

V. Phone/Fax

Practice location:
  • Phone: 575-628-0331
  • Fax: 575-628-0332
Mailing address:
  • Phone: 575-628-0331
  • Fax: 575-628-0332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCNP01235
License Number StateNM

VIII. Authorized Official

Name: JANE K CORNWELL
Title or Position: OWNER
Credential: CNP
Phone: 575-302-6683