| Doctor Name: | MRS. OLITHA JAMESETTA FOFANA |
| NPI Number: | 1013301407 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | AGPCNP-BC |
| License Number: | CNP 3783 |
| Business Practice Address: | 10911 Rhode Island Cir N Champlin, MN - 553163256 |
| Business Phone Number: | 7634932947 |
| Business Fax Number: | |
| Mailing Address: | 10911 Rhode Island Cir N, CHAMPLIN |
| State: | MN |
| Postal Code: | 553163256 |
| Phone Number: | 7634932947 |
| Fax Number: | |
| NPI Enumeration Date: | 03/24/2015 |
| NPI Last Update Date: | 03/24/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LG0600X |
| License Number: | CNP 3783 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Gerontology |
| Taxonomy Definition: | |