Provider Demographics
NPI:1912408915
Name:GOFAN, YAUKPALA INA (DNP, AGNP-C, CCRN)
Entity Type:Individual
Prefix:
First Name:YAUKPALA
Middle Name:INA
Last Name:GOFAN
Suffix:
Gender:F
Credentials:DNP, AGNP-C, CCRN
Other - Prefix:
Other - First Name:YAU
Other - Middle Name:I
Other - Last Name:GOFAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP, AGNP-C, CCRN
Mailing Address - Street 1:29490 MCDONNELL CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-1707
Mailing Address - Country:US
Mailing Address - Phone:248-766-2747
Mailing Address - Fax:
Practice Address - Street 1:4100 JOHN R ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2013
Practice Address - Country:US
Practice Address - Phone:248-581-5834
Practice Address - Fax:248-581-5635
Is Sole Proprietor?:No
Enumeration Date:2018-02-24
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704200810363LG0600X, 363LP2300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care