Provider Demographics
NPI:1235986225
Name:THIERRY, ANGELICA ARIANNE
Entity type:Individual
Prefix:MS
First Name:ANGELICA
Middle Name:ARIANNE
Last Name:THIERRY
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 1:347 GILBERT DR
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-9203
Mailing Address - Country:US
Mailing Address - Phone:337-284-0155
Mailing Address - Fax:
Practice Address - Street 1:1238 EDITH ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-5917
Practice Address - Country:US
Practice Address - Phone:337-284-0155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)