Provider Demographics
NPI:1497943476
Name:RACKENFUSE HEALTH, LLC
Entity Type:Organization
Organization Name:RACKENFUSE HEALTH, LLC
Other - Org Name:MICHELLE L. FUSELIER, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LANIECE
Authorized Official - Last Name:FUSELIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-533-5555
Mailing Address - Street 1:6305 CASTLE PL
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-1905
Mailing Address - Country:US
Mailing Address - Phone:703-533-5555
Mailing Address - Fax:703-533-5596
Practice Address - Street 1:6305 CASTLE PL
Practice Address - Street 2:SUITE 1D
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-1905
Practice Address - Country:US
Practice Address - Phone:703-533-5555
Practice Address - Fax:703-533-5596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240825261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care