Provider Demographics
NPI:1033555065
Name:DATIS, MARIE SONIA
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:SONIA
Last Name:DATIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10015 GREENBELT RD APT 304
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2234
Mailing Address - Country:US
Mailing Address - Phone:240-286-4235
Mailing Address - Fax:
Practice Address - Street 1:10015 GREENBELT RD APT 304
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2234
Practice Address - Country:US
Practice Address - Phone:240-286-4235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP#443467-7665OtherBOCWM HOME HEALTH AIDE TRAINING CENTER