Provider Demographics
NPI:1336542992
Name:FUSION HEALTH & WELLNESS
Entity type:Organization
Organization Name:FUSION HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:K
Authorized Official - Last Name:CORNWELL
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:575-302-6683
Mailing Address - Street 1:2402 W PIERCE ST STE 6G
Mailing Address - Street 2:STE 6G
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3566
Mailing Address - Country:US
Mailing Address - Phone:575-628-0331
Mailing Address - Fax:575-628-0332
Practice Address - Street 1:2402 W PIERCE ST STE 6G
Practice Address - Street 2:STE 6G
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3566
Practice Address - Country:US
Practice Address - Phone:575-628-0331
Practice Address - Fax:575-628-0332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-26
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP01235363LA2200X
363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM43580874Medicaid
NM43580874Medicaid