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Individual

MRS. OLITHA JAMESETTA FOFANA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
AGPCNP-BC

Contact information

Practice address
10911 RHODE ISLAND CIR N, CHAMPLIN, MN 55316-3256
(763) 493-2947
Mailing address
10911 RHODE ISLAND CIR N, CHAMPLIN, MN 55316-3256
(763) 493-2947

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
CNP 3783
MN
363LG0600X
Gerontology Nurse Practitioner
CNP 3783
MN
363LP2300X
Primary Care Nurse Practitioner
CNP 3783
MN

Other

Enumeration date
03/24/2015
Last updated
03/24/2015
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