Individual
DR. GWEN H LISELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2121 E HARMONY RD, STE 160, FORT COLLINS, CO 80528-3400
(970) 482-3328
(970) 482-1433
Mailing address
2121 E HARMONY RD, SUITE 160, FORT COLLINS, CO 80528-3400
(970) 482-3328
(970) 482-1433
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
33989
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01339894
—
CO
Enumeration date
06/20/2006
Last updated
01/26/2015
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