Individual
FATMATA FOFANAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
4320 BLAND RD STE 104, RALEIGH, NC 27609-6125
(301) 613-5042
Mailing address
4608 JERSEY PINE DR, ROLESVILLE, NC 27571-8746
(301) 613-5042
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2025047788
NC
Other
Enumeration date
11/28/2025
Last updated
11/28/2025
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