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General NPI Number Information
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NPI Number | 1417365776
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Entity Type | Individual
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Provider Name | NASHANDA BALOGUN AGPCNP
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Gender | Female
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Dates
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Enumeration Date | 07/30/2014
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 28 VALLEY RD # 148
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2709
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Country | US
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Telephone | 973-559-4600
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Fax | 855-998-4358
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Provider Business Mailing Address
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Address Line | 28 VALLEY RD # 148
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2709
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Country | US
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Telephone | 973-559-4600
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Fax | 855-998-4358
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | SP013879
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | SP013879
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 26NJ15053300
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License Number State | NJ
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