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Individual

DAMILOLA MARY BALOGUN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
6720 BERTNER AVE, HOUSTON, TX 77030-2604
(832) 355-2666
Mailing address
6501 FANNIN ST STE NC114, HOUSTON, TX 77030-2703
(713) 798-7356

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
968405
TX
367500000X
Certified Registered Nurse Anesthetist
623027
NY
367500000X
Certified Registered Nurse Anesthetist
968405
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
AP143223
TX
390200000X
Student in an Organized Health Care Education/Training Program

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
367500000X
NY
Enumeration date
11/01/2017
Last updated
10/11/2022
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