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Organization
BALM OF GILEAD HEALTHCARE LLC
Active
Organization
BALM OF GILEAD HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MULUH FONGWI FONGWI LADUNA FONDONG (PARTNER)
(218) 779-9437
Entity
Organization
Contact information
Practice address
1618 CENTRAL AVE NE, EAST GRAND FORKS, MN 56721-1335
(218) 779-9437
Mailing address
2448 42ND AVE S, GRAND FORKS, ND 58201-3483
(218) 779-9437
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
03/07/2023
Last updated
03/07/2023
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