Provider Demographics
NPI:1851101356
Name:ATAWAN, ODETTE A
Entity type:Individual
Prefix:
First Name:ODETTE
Middle Name:A
Last Name:ATAWAN
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 1:4606 ADDISON RD
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-1003
Mailing Address - Country:US
Mailing Address - Phone:202-541-9844
Mailing Address - Fax:
Practice Address - Street 1:4606 ADDISON RD
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-1003
Practice Address - Country:US
Practice Address - Phone:202-541-9844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00222918376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide