Individual
OLUSHOLA A. BALOGUN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
811 W JEFFERSON ST, GRAND PRAIRIE, TX 75051-1645
(214) 662-2675
Mailing address
811 W JEFFERSON ST, GRAND PRAIRIE, TX 75051-1645
(214) 662-2675
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
1000117
TX
Other
Enumeration date
04/27/2024
Last updated
09/06/2024
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