Provider Demographics
NPI:1093609604
Name:DATAN, AGNES R
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:R
Last Name:DATAN
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 1:8035 GEORGIA CT
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-2662
Mailing Address - Country:US
Mailing Address - Phone:443-557-8320
Mailing Address - Fax:
Practice Address - Street 1:857 SUNNY CHAPEL RD
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-2536
Practice Address - Country:US
Practice Address - Phone:202-374-2744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00212776376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide