Provider Demographics
NPI:1245800572
Name:FOFANA, HAJA HUMU (NP)
Entity type:Individual
Prefix:
First Name:HAJA
Middle Name:HUMU
Last Name:FOFANA
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:960 MASSACHUSETTS AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 MASSACHUSETTS AVE
Practice Address - Street 2:SUITE 6C, CROSSTOWN BUILDING
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-414-5951
Practice Address - Fax:617-414-9201
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2025-05-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MARN2307690363LF0000X, 163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP0200XNursing Service ProvidersRegistered NursePediatrics