Healthcare Provider Details

I. General information

NPI: 1073096244
Provider Name (Legal Business Name): ABIGAIL DOWNS ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 UNIVERSITY BLVD
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

21297 WHEATON LN
NOVI MI
48375-4757
US

V. Phone/Fax

Practice location:
  • Phone: 248-767-1567
  • Fax:
Mailing address:
  • Phone: 248-767-1567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberAT803
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT803
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: