Individual
LAURIE A. FONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN,CNP
Contact information
Practice address
1027 WASHINGTON AVE, DETROIT LAKES, MN 56501-3409
(218) 847-5611
(218) 847-0881
Mailing address
1027 WASHINGTON AVE, DETROIT LAKES, MN 56501-3409
(218) 847-5611
(218) 847-0881
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R-073941-0
MN
364SP0809X
Adult Psychiatric/Mental Health Clinical Nurse Specialist
R-073941-0
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1015289
PREFERREDONE
MN
01
—
109897
UCARE MINNESOTA
MN
05
—
1568419612
—
MN
01
—
444M0FO
BLUE SHIELD OF MN
MN
01
—
62-51179
UNITED BEHAVIORAL HEALTH
MN
05
—
71289
—
ND
05
—
908239500
—
MN
01
—
HP19196
HEALTHPARTNERS
MN
Enumeration date
05/27/2006
Last updated
12/23/2015
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