Provider Demographics
NPI:1497112700
Name:RICHBURG, ANGELA
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:RICHBURG
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 1:7285 WOOLMARKET RD
Mailing Address - Street 2:H350
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-7846
Mailing Address - Country:US
Mailing Address - Phone:228-547-4668
Mailing Address - Fax:
Practice Address - Street 1:7285 WOOLMARKET RD
Practice Address - Street 2:H350
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-7846
Practice Address - Country:US
Practice Address - Phone:228-547-4668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No372600000XNursing Service Related ProvidersAdult Companion