RAQUEL SHELLY SOLIVAN (NPI# 1528379732) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528379732 |
| Entity Type | Individual |
| Full Name | RAQUEL SHELLY SOLIVAN |
| Credential | IDMT |
| Practice Address |
49th Medical Group/sgpf 280 First Street, Bldg 23 Holloman Afb NM 88330-8273 |
| Practice Telephone | 5755722446 |
| Practice Fax Number | 5755722259 |
| Mailing Telephone | 5755722446 |
| Mailing Fax Number | 5755722259 |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2018-04-30 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1002X |
Military Health Care Provider Specialization: Independent Duty Corpsman |
Other Service Providers | ||
| N | 1710I1003X |
Military Health Care Provider Specialization: Independent Duty Medical Technicians |
Other Service Providers |
| Street Address |
49TH MEDICAL GROUP/SGPF 280 FIRST STREET, BLDG 23 |
| City | HOLLOMAN AFB |
| State | NM |
| Zip Code | 88330-8273 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326029760 | Franklin Devon Waddell | Pediatrics | 49th Medical Group/sgpf, 280 First Street, Bldg 23, Holloman Afb, NM 88330-8273 | 2005-11-11 |
| 1467686154 | Hayley Michelle Crandall | Military Health Care Provider | 49th Medical Group/sgpf, 280 First Street, Bldg 23, Holloman Afb, NM 88330-8273 | 2009-05-08 |
| 1679756910 | Jo Ann Schroeder | Nurse Practitioner | 49th Medical Group/sgpf, 280 First St Bldg 23, Holloman Afb, NM 88330-8273 | 2007-12-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598312084 | Zachary James Smith | Pharmacist | 49th Medical Group 280 First Street, Holloman Afb, NM 88330 | 2019-08-20 |
| 1346776804 | Maxilea Isom | Behavior Technician | 2079 Eglin Ave Apt A, Holloman, Afb, NM 88330 | 2017-05-03 |
| 1932558665 | Courtney Davis | Day Training/Habilitation Specialist | 2228 La Luz Pkwy Unit A, Holloman Afb, NM 88330 | 2016-06-03 |
| 1568849255 | Ryan Abner | Registered Nurse | 49th Medical Building 17, Holloman Afb, NM 88330 | 2015-05-01 |
| 1710384292 | United States Air Force | Military Hospital | 49th Medical Bldg 17, Holloman Afb, NM 88330 | 2014-11-26 |
| 1174934764 | Jason Gordon | Social Worker | 1st Street Holloman Afb, Holloman Afb, NM 88330 | 2014-05-16 |
| 1649512807 | Philip Walker | Internal Medicine | 280 1st St, Holloman Afb, Alamogordo, NM 88330 | 2013-03-25 |
| 1275891889 | Sunland Optical Co., Inc. | Eyewear Supplier (Equipment, not the service) | 551 4th Street, Bldg. 227, Holloman Afb, NM 88330 | 2012-05-02 |
| 1568606317 | Kimberly Dawn Jensen | Internal Medicine | 280 1st St Bldg 15, 49 Mdg Holloman Afb, Holloman Afb, NM 88330 | 2009-04-23 |
| 1700042306 | Bettina Watkins | Family Medicine | 280 First St, Bldg 23, Holloman Afb, NM 88330 | 2008-08-03 |
| Find all providers in zip 88330 | ||||
| Taxonomy Code | 1710I1002X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Corpsman |
| A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals. |
| Notes: Source: Bureau of Medicine and Surgery, Department of the Navy [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467686154 | Hayley Michelle Crandall | Military Health Care Provider | 49th Medical Group/sgpf, 280 First Street, Bldg 23, Holloman Afb, NM 88330-8273 | 2009-05-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811529969 | Aleksandr Volk Sergojan | Military Health Care Provider | 8810 South St Se, Albuquerque, NM 87117-0001 | 2020-02-06 |
| City | HOLLOMAN AFB |
| Zip Code | 88330 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.