Healthcare Provider Details

I. General information

NPI: 1215049283
Provider Name (Legal Business Name): ANGELA VICTORIA THRAHSER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 G ST ARNOLD ANNEX, BLDG 5901
BILOXI MS
39534-2410
US

IV. Provider business mailing address

151 GRANDE VIEW DR APT #221
BILOXI MS
39531-4717
US

V. Phone/Fax

Practice location:
  • Phone: 228-377-0801
  • Fax: 228-377-0371
Mailing address:
  • Phone: 240-606-2416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberPT1120
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberPT870615
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: