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General NPI Number Information
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NPI Number | 1851744213
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Entity Type | Individual
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Provider Name | ANGELICA TRIEU
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Gender | Female
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Dates
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Enumeration Date | 07/20/2016
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Last Update Date | 07/20/2016
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Provider Practice Location Address
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Address Line | 10828 HIGHWAY 57
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City | VANCLEAVE
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State | MS
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Zip | 39565-8264
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Country | US
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Telephone | 228-826-4711
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Fax |
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Provider Business Mailing Address
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Address Line | 14500 PINE RIDGE RD
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City | OCEAN SPRINGS
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State | MS
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Zip | 39565-7807
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Country | US
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Telephone | 504-495-9087
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 901484
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License Number State | MS
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