Provider Demographics
NPI:1417365776
Name:BALOGUN, NASHANDA (AGPCNP)
Entity Type:Individual
Prefix:
First Name:NASHANDA
Middle Name:
Last Name:BALOGUN
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 FOUR FALLS CORPORATE CENTER, SUITE 260
Mailing Address - Street 2:
Mailing Address - City:WEST CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1456
Mailing Address - Country:US
Mailing Address - Phone:844-826-3446
Mailing Address - Fax:
Practice Address - Street 1:300 FOUR FALLS CORPORATE CENTER, SUITE 260
Practice Address - Street 2:
Practice Address - City:WEST CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1942
Practice Address - Country:US
Practice Address - Phone:844-826-3446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-30
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013879363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology