Provider Demographics
NPI:1598493090
Name:MILLSAP, BREANNA (RN)
Entity Type:Individual
Prefix:MRS
First Name:BREANNA
Middle Name:
Last Name:MILLSAP
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:BREANNA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2011 49TH ST NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44705-3024
Mailing Address - Country:US
Mailing Address - Phone:330-209-6894
Mailing Address - Fax:
Practice Address - Street 1:3745 WHIPPLE AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-4805
Practice Address - Country:US
Practice Address - Phone:330-331-7506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0033978363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health