Active NPI
Olivia Wallman
- Student in an Organized Health Care Education/Training Program
- Cannon Afb, NM
National Provider Identifier
1669380309
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 27TH Somdg 224 W D.L. Ingram Avenue BLDG 1408
BLDG 1408
Cannon Afb, NM 88103 - Phone
- (575) 784-2778
- NPI assigned
- Sep 1, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
27TH Somdg 224 W D.L. Ingram Avenue BLDG 1408
BLDG 1408
Cannon Afb, NM 88103
Mailing address
5825 NW Conus CT
Port St Lucie, FL 34986-3601
Phone (772) 418-4084
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1788220800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788912000000",
"number": "1669380309",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5825 NW CONUS CT",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349863601",
"telephone_number": "772-418-4084"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "27TH SOMDG 224 W D.L. INGRAM AVENUE BLDG 1408",
"address_2": "BLDG 1408",
"city": "CANNON AFB",
"state": "NM",
"postal_code": "88103",
"telephone_number": "575-784-2778"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLMAN",
"first_name": "OLIVIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-09-01",
"last_updated": "2026-09-09",
"certification_date": "2026-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cannon Afb, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.