Provider Demographics
NPI:1679965602
Name:FOFANAH, HAWA (CRNP)
Entity Type:Individual
Prefix:
First Name:HAWA
Middle Name:
Last Name:FOFANAH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2275 RESEARCH BLVD # 500-72
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3268
Mailing Address - Country:US
Mailing Address - Phone:301-288-1600
Mailing Address - Fax:301-517-9276
Practice Address - Street 1:1451 ROCKVILLE PIKE STE 250
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1486
Practice Address - Country:US
Practice Address - Phone:301-288-1600
Practice Address - Fax:301-517-9276
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR214435363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily