MEDICARE: ANGELICA TRIEU

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	363LP0200X	Pediatric Nurse Practitioner	901484	MS

General Provider Information

NPI Number	:	1851744213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELICA TRIEU

Provider Business Mailing Address
First Line	:	14500 PINE RIDGE RD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39565-7807
Country	:	US
Telephone Number	:	504-495-9087
Fax Number	:

Provider Business Practice Location Address
First Line	:	10828 HIGHWAY 57
Second Line	:
City	:	VANCLEAVE
State	:	MS
Zip	:	39565-8264
Country	:	US
Telephone Number	:	228-826-4711
Fax Number	:

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

Provider Enumeration Date	:	07/20/2016
Last Update Date	:	07/20/2016

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Directions to “ ANGELICA TRIEU ” Practice Location

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