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General NPI Number Information
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NPI Number | 1205424694
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Entity Type | Individual
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Provider Name | OLUWATOSIN AISHAT BALOGUN
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Gender | Female
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Dates
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Enumeration Date | 01/02/2021
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 26750 FM 1093 RD STE 170
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City | RICHMOND
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State | TX
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Zip | 77406-2786
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Country | US
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Telephone | 281-875-8428
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Fax |
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Provider Business Mailing Address
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Address Line | 450 GEARS RD STE 450
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City | HOUSTON
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State | TX
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Zip | 77067-4542
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Country | US
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Telephone | 281-874-0212
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Fax |
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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 | 1035445
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9387682
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN301656
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License Number State | GA
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