Provider Demographics
NPI:1356889521
Name:THATCHER, ANGELA GARDNER (PA-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:GARDNER
Last Name:THATCHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 S WHITE ST
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-2920
Mailing Address - Country:US
Mailing Address - Phone:919-435-2154
Mailing Address - Fax:888-355-2154
Practice Address - Street 1:525 S WHITE ST
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-2920
Practice Address - Country:US
Practice Address - Phone:919-435-2154
Practice Address - Fax:888-355-2154
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-07039363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant