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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