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General NPI Number Information
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NPI Number | 1215049283
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Entity Type | Individual
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Provider Name | ANGELA VICTORIA THRAHSER
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 111 G ST ARNOLD ANNEX, BLDG 5901
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City | BILOXI
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State | MS
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Zip | 39534-2410
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Country | US
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Telephone | 228-377-0801
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Fax | 228-377-0371
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Provider Business Mailing Address
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Address Line | 151 GRANDE VIEW DR APT #221
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City | BILOXI
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State | MS
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Zip | 39531-4717
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Country | US
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Telephone | 240-606-2416
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | PT1120
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | PT870615
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License Number State | DC
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