Provider Demographics
NPI:1831165216
Name:MANGUM, ANGEL KAHIHIKOLO (CRNA)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:KAHIHIKOLO
Last Name:MANGUM
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ANGEL DAWN
Other - Middle Name:LEILANI
Other - Last Name:KAHIHIKOLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1146 THOMPSON CIR
Mailing Address - Street 2:
Mailing Address - City:FORT EUSTIS
Mailing Address - State:VA
Mailing Address - Zip Code:23604-1407
Mailing Address - Country:US
Mailing Address - Phone:913-237-1393
Mailing Address - Fax:
Practice Address - Street 1:576 JEFFERSON AVE
Practice Address - Street 2:MCDONALD ARMY HEALTH CENTER
Practice Address - City:FORT EUSTIS
Practice Address - State:VA
Practice Address - Zip Code:23604-5548
Practice Address - Country:US
Practice Address - Phone:757-314-7854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-14151367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYVAD000Medicare UPIN