Provider Demographics
NPI:1447899463
Name:FUSELIER, BRENDA LEE (CNP-APRN)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEE
Last Name:FUSELIER
Suffix:
Gender:F
Credentials:CNP-APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-0055
Mailing Address - Country:US
Mailing Address - Phone:575-226-3023
Mailing Address - Fax:
Practice Address - Street 1:304 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-6218
Practice Address - Country:US
Practice Address - Phone:575-226-3023
Practice Address - Fax:575-226-3024
Is Sole Proprietor?:No
Enumeration Date:2019-12-23
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM60176363LF0000X, 363L00000X
NMR43905363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily