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General NPI Number Information
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NPI Number | 1093609604
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Entity Type | Individual
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Provider Name | AGNES R. DATAN
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Gender | Female
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Dates
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Enumeration Date | 06/06/2025
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 857 SUNNY CHAPEL RD
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City | ODENTON
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State | MD
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Zip | 21113-2536
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Country | US
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Telephone | 202-374-2744
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Fax |
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Provider Business Mailing Address
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Address Line | 8035 GEORGIA CT
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City | SEVERN
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State | MD
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Zip | 21144-2662
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Country | US
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Telephone | 443-557-8320
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | A00212776
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License Number State | MD
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