Provider Demographics
NPI:1144727900
Name:THOMAS, ANGELA DOYLEAN (RN-C, BSN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:DOYLEAN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RN-C, BSN
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:DOYLEAN
Other - Last Name:RASCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4238 FM 1607
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:TX
Mailing Address - Zip Code:79549-0978
Mailing Address - Country:US
Mailing Address - Phone:325-636-3849
Mailing Address - Fax:325-268-5184
Practice Address - Street 1:4300 AVENUE V
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:TX
Practice Address - Zip Code:79549-6077
Practice Address - Country:US
Practice Address - Phone:325-574-8676
Practice Address - Fax:325-268-5184
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX684752251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX355223401Medicaid
TX355223402Medicaid