Organization
N&T COMMUNITY OUTREACH CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NEH FONCHAM (OWNER)
(651) 470-3265
Entity
Organization
Contact information
Practice address
20416 EVERTON TRL N, FOREST LAKE, MN 55025-8161
(651) 470-3265
Mailing address
20416 EVERTON TRL N, FOREST LAKE, MN 55025-8161
(651) 470-3265
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/09/2025
Last updated
10/09/2025
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