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General NPI Number Information
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NPI Number | 1306221460
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Entity Type | Individual
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Provider Name | MERIT FL FONDONG NP
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Gender | Female
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Dates
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Enumeration Date | 07/29/2015
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 210 GATEWAY DR NE STE 1
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City | EAST GRAND FORKS
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State | MN
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Zip | 56721-1621
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Country | US
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Telephone | 218-207-2020
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Fax | 800-582-1083
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Provider Business Mailing Address
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Address Line | 210 GATEWAY DR NE STE 1
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City | EAST GRAND FORKS
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State | MN
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Zip | 56721-1621
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Country | US
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Telephone | 218-207-2020
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Fax | 800-582-1083
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R219786-9
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4015
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License Number State | MN
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