Individual
MRS. ANN RAQUEL MCMILLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
510 MALACHITE STREET, TYRONE, NM 88065
(505) 538-1919
Mailing address
510 MALACHITE STREET, PO BOX 46, TYRONE, NM 88061
(575) 538-1919
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
05/29/2007
Last updated
02/17/2009
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