{
"Npi": {
"NPI": "1831165216",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MANGUM",
"FirstName": "ANGEL",
"MiddleName": "KAHIHIKOLO",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "CRNA",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "KAHIHIKOLO",
"OtherFirstName": "ANGEL DAWN",
"OtherMiddleName": "LEILANI",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "RN",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "1146 THOMPSON CIR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FORT EUSTIS",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "23604-1407",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "913-237-1393",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "576 JEFFERSON AVE",
"SecondLinePracticeLocationAddress": "MCDONALD ARMY HEALTH CENTER",
"PracticeLocationAddressCityName": "FORT EUSTIS",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "23604-5548",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "757-314-7854",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/27/2006",
"LastUpdateDate": "07/28/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "367500000X",
"TaxonomyName": "Certified Registered Nurse Anesthetist",
"LicenseNumber": "1-14151",
"LicenseNumberStateCode": "AL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}