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Contact Information

GWEN H LISELLA, MD
2121 E HARMONY RD
STE 160
FORT COLLINS, CO80528-3400
 Phone: 970-482-3328
 Fax: 970-482-1433
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Radiation Oncology

2085R0001X 92 Physician/Radiation Oncology
Indicates primary specialty

NPI Profile & details for GWEN H LISELLA · (Female)

NPI # 1457397440
Status Active
Credentials MD
Entity Individual
Enumeration date 06/20/2006
Last updated 01/26/2015 - About 11 years ago
Sole proprietor 1 No
Identifiers
  • CO License # 33989
  • CO Medicaid 01339894
Hospital affiliation(s)
  • POUDRE VALLEY HOSPITAL - (Acute Care)
    1024 S LEMAY AVE
    FORT COLLINS, CO 80524
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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