Provider Demographics
NPI:1013699693
Name:BALOGUN, ERONMWON (APN)
Entity Type:Individual
Prefix:
First Name:ERONMWON
Middle Name:
Last Name:BALOGUN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1181 NIXON DR
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3201
Mailing Address - Country:US
Mailing Address - Phone:609-444-8109
Mailing Address - Fax:
Practice Address - Street 1:1181 NIXON DR. SUITE 1098
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3201
Practice Address - Country:US
Practice Address - Phone:609-444-8109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR1900140163WP0807X
NJ26NJ14894800363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & AdolescentGroup - Single Specialty