Healthcare Provider Details

I. General information

NPI: 1578281572
Provider Name (Legal Business Name): FUSION HEALTH & WELLNESS OF NEW MEXICO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

2402 W PIERCE ST 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 TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: REBECCA ANN NOLEN
Title or Position: OWNER
Credential: CNP
Phone: 575-628-0331