Provider Demographics
NPI:1447569710
Name:MILLSAPE, KATRINA E (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:E
Last Name:MILLSAPE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:E
Other - Last Name:MILLSAPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:8813 WALTHAM WOODS RD
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-2450
Mailing Address - Country:US
Mailing Address - Phone:410-661-4670
Mailing Address - Fax:
Practice Address - Street 1:8813 WALTHAM WOODS RD
Practice Address - Street 2:SUITE 204
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-2450
Practice Address - Country:US
Practice Address - Phone:216-410-4976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.11711-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner