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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