Provider Demographics
NPI:1790760742
Name:MCMILLAN, SUSAN K (APNP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:K
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-5429
Mailing Address - Country:US
Mailing Address - Phone:608-782-7300
Mailing Address - Fax:
Practice Address - Street 1:106 E MAIN ST
Practice Address - Street 2:BOX 538
Practice Address - City:CALMAR
Practice Address - State:IA
Practice Address - Zip Code:52132-7743
Practice Address - Country:US
Practice Address - Phone:563-562-3211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1499033363LF0000X
IAA-073625363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43905000Medicaid
WI43905000Medicaid
S90571Medicare UPIN