Provider Demographics
NPI:1245800572
Name:FOFANA, HAJA HUMU (RN)
Entity Type:Individual
Prefix:
First Name:HAJA
Middle Name:HUMU
Last Name:FOFANA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 ROCKLAND ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-2222
Mailing Address - Country:US
Mailing Address - Phone:781-826-8381
Mailing Address - Fax:
Practice Address - Street 1:207 ROCKLAND ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-2222
Practice Address - Country:US
Practice Address - Phone:781-826-8381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2307690363LF0000X, 163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP0200XNursing Service ProvidersRegistered NursePediatrics