1356379978 NPI number — ELEANOR G MILLSAP ARNP

Table of content: ELEANOR G MILLSAP ARNP (NPI 1356379978)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356379978 NPI number — ELEANOR G MILLSAP ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLSAP
Provider First Name:
ELEANOR
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356379978
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6120 SHADYBROOK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67208-1862
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-269-5000
Provider Business Mailing Address Fax Number:
316-269-0404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1315 N WEST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67203-1382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-943-1295
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  44970 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200381990A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00353059 . This is a "RAIL ROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 161720 . This is a "BLUECROSS BLUESHIELD KS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".