Healthcare Provider Details

I. General information

NPI: 1265206106
Provider Name (Legal Business Name): FOUNDATIONS NATURAL MEDICINE PLLC DBA LAGOM WELLNESS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2023
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3441 45TH ST S STE B
FARGO ND
58104-8970
US

IV. Provider business mailing address

3441 45TH ST S STE B
FARGO ND
58104-8970
US

V. Phone/Fax

Practice location:
  • Phone: 701-552-6573
  • Fax:
Mailing address:
  • Phone: 701-552-6573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. TONYA LOKEN
Title or Position: OWNER
Credential: ND, APRN, FNP-C
Phone: 701-552-6573