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General NPI Number Information
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NPI Number | 1548537038
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Entity Type | Organization
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Legal Business Name | FUSION WOMEN'S HEALTH AND WELLNESS, PLLC
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Dates
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Enumeration Date | 11/28/2011
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Last Update Date | 04/12/2012
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Provider Practice Location Address
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Address Line | 7250 HAWKINS VIEW DR SUITE 411
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City | FORT WORTH
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State | TX
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Zip | 76132-3920
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Country | US
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Telephone | 806-468-4317
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 164698
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City | FT WORTH
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State | TX
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Zip | 76161-4698
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN
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Name | DR. LISA L GARDNER
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Credential | D.O.
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Telephone | 806-468-4317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 34-007697
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License Number State | TX
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