Organization
FUSION WOMEN'S HEALTH AND WELLNESS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA L GARDNER D.O. (PRESIDENT/PHYSICIAN)
(806) 468-4317
Entity
Organization
Contact information
Practice address
7250 HAWKINS VIEW DR, SUITE 411, FORT WORTH, TX 76132-3920
(806) 468-4317
Mailing address
PO BOX 164698, FT WORTH, TX 76161-4698
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
34-007697
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
172373602
—
TX
Enumeration date
11/28/2011
Last updated
04/12/2012
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