Provider Demographics
NPI:1982436879
Name:NEXTGEN NURTURE
Entity type:Organization
Organization Name:NEXTGEN NURTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:FREWINE
Authorized Official - Middle Name:
Authorized Official - Last Name:OGBASELASE
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:267-314-7501
Mailing Address - Street 1:701 E CATHEDRAL RD STE 45
Mailing Address - Street 2:#421
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128
Mailing Address - Country:US
Mailing Address - Phone:267-314-7501
Mailing Address - Fax:
Practice Address - Street 1:701 E CATHEDRAL RD STE 45
Practice Address - Street 2:#421
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128
Practice Address - Country:US
Practice Address - Phone:267-314-7501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty