Provider Demographics
NPI:1952675589
Name:MILLSAPP, ANNICE VIOLA (LPN)
Entity Type:Individual
Prefix:MS
First Name:ANNICE
Middle Name:VIOLA
Last Name:MILLSAPP
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:ANNICE
Other - Middle Name:VIOLA
Other - Last Name:MILLSAPP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNA
Mailing Address - Street 1:3030 W MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-4606
Mailing Address - Country:US
Mailing Address - Phone:414-616-1922
Mailing Address - Fax:
Practice Address - Street 1:3030 W MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-4606
Practice Address - Country:US
Practice Address - Phone:414-616-1922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31516131164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse