Provider Demographics
NPI:1144651951
Name:AGIATO, MARIA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:AGIATO
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4024 STIRRUP CREEK DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-9464
Mailing Address - Country:US
Mailing Address - Phone:919-908-0356
Mailing Address - Fax:919-230-0148
Practice Address - Street 1:4024 STIRRUP CREEK DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-9464
Practice Address - Country:US
Practice Address - Phone:919-908-0356
Practice Address - Fax:919-230-0148
Is Sole Proprietor?:No
Enumeration Date:2013-12-04
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC268709363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1144651951Medicaid