Individual
MRS. VICTORIA ANNE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
1931 EAGAN AVE, FAIRBANKS CORRECTIONAL CENTER, FAIRBANKS, AK 99701-5703
(907) 458-6700
Mailing address
1931 EAGAN AVE, FAIRBANKS CORRECTIONAL CENTER, FAIRBANKS, AK 99701-5703
(907) 458-6700
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
713
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP0254
—
AK
05
—
NP02541
—
AK
Enumeration date
07/10/2006
Last updated
03/07/2023
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