Provider Demographics
NPI:1225572506
Name:FOFANA, MAKEISA
Entity type:Individual
Prefix:
First Name:MAKEISA
Middle Name:
Last Name:FOFANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:891 HUNT ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-2309
Mailing Address - Country:US
Mailing Address - Phone:202-378-7427
Mailing Address - Fax:
Practice Address - Street 1:891 HUNT ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-2309
Practice Address - Country:US
Practice Address - Phone:202-378-7427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-06
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty