Provider Demographics
NPI:1992067011
Name:FOFANA, HAMIDOU
Entity type:Individual
Prefix:
First Name:HAMIDOU
Middle Name:
Last Name:FOFANA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 MENDON CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-5467
Mailing Address - Country:US
Mailing Address - Phone:614-577-1765
Mailing Address - Fax:
Practice Address - Street 1:4226 SESTOS DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-8431
Practice Address - Country:US
Practice Address - Phone:614-735-9273
Practice Address - Fax:614-295-8462
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-14
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.482536163WH0200X
171W00000X, 385HR2060X, 376K00000X
OH159087164W00000X
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No171W00000XOther Service ProvidersContractor
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No376J00000XNursing Service Related ProvidersHomemaker