MEDICARE: ODETTE A ATAWAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide	A00222918	MD
2	374U00000X	Home Health Aide	HHA200004572	DC

General Provider Information

NPI Number	:	1851101356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ODETTE A ATAWAN

Provider Business Mailing Address
First Line	:	4606 ADDISON RD
Second Line	:
City	:	CAPITOL HEIGHTS
State	:	MD
Zip	:	20743-1003
Country	:	US
Telephone Number	:	202-541-9844
Fax Number	:

Provider Business Practice Location Address
First Line	:	4606 ADDISON RD
Second Line	:
City	:	CAPITOL HEIGHTS
State	:	MD
Zip	:	20743-1003
Country	:	US
Telephone Number	:	202-541-9844
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2025
Last Update Date	:	07/28/2025

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Directions to “ ODETTE A ATAWAN ” Practice Location

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