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Organization
BALM OF GILEAD HEALTHCARE CLINIC LLC
Active
Organization
BALM OF GILEAD HEALTHCARE CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MERIT FONGWI LADUNA FONDONG (NP)
(218) 779-9437
Entity
Organization
Contact information
Practice address
210 GATEWAY DR NE STE 1, EAST GRAND FORKS, MN 56721-1621
(218) 207-2020
(800) 582-1083
Mailing address
210 GATEWAY DR NE STE 1, EAST GRAND FORKS, MN 56721-1621
(218) 207-2020
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
03/10/2023
Last updated
02/10/2025
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