Healthcare Provider Details

I. General information

NPI: 1467696476
Provider Name (Legal Business Name): ABIGAIL LYNN MILLS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 04/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

879 LANCELOT ST
LOS LUNAS NM
87031
US

IV. Provider business mailing address

PO BOX 11211
ALBUQUERQUE NM
87109
US

V. Phone/Fax

Practice location:
  • Phone: 505-261-0229
  • Fax:
Mailing address:
  • Phone: 505-401-4357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number3753
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: