Provider Demographics
NPI:1215049283
Name:THRAHSER, ANGELA VICTORIA
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:VICTORIA
Last Name:THRAHSER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 GRANDE VIEW DR
Mailing Address - Street 2:APT #221
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-4717
Mailing Address - Country:US
Mailing Address - Phone:240-606-2416
Mailing Address - Fax:
Practice Address - Street 1:111 G ST
Practice Address - Street 2:ARNOLD ANNEX, BLDG 5901
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39534-2410
Practice Address - Country:US
Practice Address - Phone:228-377-0801
Practice Address - Fax:228-377-0371
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1120171000000X
DCPT870615171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider