Provider Demographics
NPI:1356379978
Name:MILLSAP, ELEANOR G (ARNP)
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:G
Last Name:MILLSAP
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6120 SHADYBROOK ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-1862
Mailing Address - Country:US
Mailing Address - Phone:316-269-5000
Mailing Address - Fax:316-269-0404
Practice Address - Street 1:1315 N WEST ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-1382
Practice Address - Country:US
Practice Address - Phone:316-943-1295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44970363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200381990AMedicaid
P00353059OtherRAIL ROAD MEDICARE
KS161720OtherBLUECROSS BLUESHIELD KS
KS200381990AMedicaid