Provider Demographics
NPI:1780885954
Name:MCMILLAN, ANN RAQUEL (ATC)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:RAQUEL
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 MALACHITE STREET
Mailing Address - Street 2:PO BOX 46
Mailing Address - City:TYRONE
Mailing Address - State:NM
Mailing Address - Zip Code:88061
Mailing Address - Country:US
Mailing Address - Phone:575-538-1919
Mailing Address - Fax:
Practice Address - Street 1:510 MALACHITE STREET
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:NM
Practice Address - Zip Code:88065
Practice Address - Country:US
Practice Address - Phone:505-538-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer