Provider Demographics
NPI:1124883228
Name:FOFANA, AICHA (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:AICHA
Middle Name:
Last Name:FOFANA
Suffix:
Gender:
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 7TH AVE W UNIT 7114
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-7005
Mailing Address - Country:US
Mailing Address - Phone:862-235-7886
Mailing Address - Fax:
Practice Address - Street 1:374 7TH AVE W UNIT 7114
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-7005
Practice Address - Country:US
Practice Address - Phone:862-235-7886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-16
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15062600363LP0200X
NY353531207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine