Ann Raquel McMillan, ATC
Individual provider Active NPI Athletic Trainer · Tyrone, NM
NPI 1780885954 · NPPES record last updated Feb 17, 2009
Key facts
- NPI
- 1780885954
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- Practice address
- 510 Malachite Street
Tyrone, NM 88065 - Phone
- (505) 538-1919
- NPI assigned
- May 29, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | Yes |
Addresses
Primary practice location
510 Malachite Street
Tyrone, NM 88065
Mailing address
510 Malachite Street
PO Box 46
Tyrone, NM 88061
Phone (575) 538-1919
Other providers in Tyrone, NM
All providers in Tyrone, NM · Athletic Trainer in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 17, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.