Provider Demographics
NPI:1447569710
Name:MILLSAPE, KATRINA E (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:E
Last Name:MILLSAPE
Suffix:
Gender:
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:E
Other - Last Name:MILLSAPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:800 TYDINGS LN
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-2102
Mailing Address - Country:US
Mailing Address - Phone:410-273-2205
Mailing Address - Fax:
Practice Address - Street 1:800 TYINGS LANE
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078
Practice Address - Country:US
Practice Address - Phone:410-273-2205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR203265363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health