Individual
MEDINAT OMOBOLANLE BALOGUN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2848 MCDONOUGH ST, JOLIET, IL 60436-1050
(815) 730-4400
Mailing address
10010 W 190TH PL, MOKENA, IL 60448-8752
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209022340
IL
Other
Enumeration date
11/17/2020
Last updated
11/17/2020
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