Wallace, Victoria Anne

Wallace, Victoria Anne is an individual health care provider with primary practice located at 1931 Eagan Ave Fairbanks Correctional Center, Fairbanks AK 99701-5703. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Wallace, Victoria Anne can be contacted via phone (907) 458-6700.

Contact Information

Primary practice address
1931 Eagan Ave Fairbanks Correctional Center Fairbanks AK 99701-5703
Phone: (907) 458-6700
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 713 Alaska

Profile Details

NPI number 1295769859
LBN Legal business name Wallace, Victoria Anne
Credentials Adult Nurse Practitioner (ANP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 10th, 2006
Last updated Mar 7th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1295769859 NPPES
Alaska MEDICAID NP0254
Alaska MEDICAID NP02541

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