MRS. VICTORIA ANNE WALLACE (NPI# 1295769859) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295769859 |
| Entity Type | Individual |
| Full Name | MRS. VICTORIA ANNE WALLACE |
| Credential | ANP |
| Practice Address |
1931 Eagan Ave Fairbanks Correctional Center Fairbanks AK 99701-5703 |
| Practice Telephone | 9074586700 |
| Mailing Telephone | 9074586700 |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2012-06-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
713 | AK | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | DEA | MB0647238 | 01 |
| AK | NP02541 | 05 | |
| AK | NP0254 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952820292 | Victoria Lynn Wallace | Counselor | 79 Bonnymede Rd, Apt 104, Pueblo, CO 81001-8100 | 2017-09-19 |
| 1487075271 | Victoria Lee Wallace | Social Worker | 1314 Victoria St, Apt. 1002, Honolulu, HI 96814-1048 | 2013-12-20 |
| 1811279268 | Victoria L Wallace | Pharmacist | 405 S 8th Street, Payette, ID 83661 | 2011-09-12 |
| 1326353442 | Victoria Wallace | Social Worker | 112 Desirable Lane, Monroe, LA 71203 | 2010-08-12 |
| 1295873933 | Victoria Lynn Wallace | Counselor | 5643 Ne Alberta St, Portland, OR 97218-2557 | 2007-02-02 |
| 1629386552 | Victoria Wallace | Licensed Practical Nurse | 3737 Lander Rd, Pepper Pike, OH 44124-5712 | 2010-09-14 |
| Street Address |
1931 EAGAN AVE FAIRBANKS CORRECTIONAL CENTER |
| City | FAIRBANKS |
| State | AK |
| Zip Code | 99701-5703 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801264320 | April Lynn Smith | Physician Assistant | 1931 Eagan Ave, Fairbanks, AK 99701-5703 | 2015-09-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659984987 | Resource Center for Parents & Children, Inc. | Social Worker | 726 26th Ave, Suite #2, Fairbanks, AK 99701 | 2020-08-26 |
| 1134738982 | Aaron Paul Sarauer | Behavior Technician | 3121 Lathrop St., Fairbanks, AK 99701 | 2020-07-28 |
| 1437715505 | Fabienne Rose Marie Siddall | Case Manager/Care Coordinator | 122 1st Avenue, Fairbanks, AK 99701 | 2019-05-14 |
| 1902461957 | Jacqueline Marie Rahm | Counselor | Family Centered Services of Alaska - Rtc, 3101 Lathrop St., Fairbanks, AK 99701 | 2019-05-06 |
| 1821588989 | Corrie Wilson | Nurse Practitioner | 1025 Barnette Street, Fairbanks, AK 99701 | 2018-05-15 |
| 1922519305 | Sarishma Sangeeta Lal | Registered Nurse | 815 2nd Ave Ste 122, Fairbanks, AK 99701 | 2017-10-12 |
| 1245690569 | Christine L Simko | Naturopath | 1275 Sadler Way, Ste 100 Rm 147, Fairbanks, AK 99701 | 2016-02-29 |
| 1932581600 | Jennifer Davis | Registered Nurse | 1025 West Barnette St., Fairbanks, AK 99701 | 2015-06-18 |
| 1700272705 | John D. Zipperer Jr Md, LLC | Clinic/Center | 751 Old Richardson Hwy., Fairbanks, AK 99701 | 2015-04-07 |
| 1578957460 | Mara Justine Becker | Physician Assistant | 1717 W. Cowles St, Fairbanks, AK- ALASKA 99701 | 2015-03-27 |
| Find all providers in zip 99701 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710535380 | Peter Harvey | Nurse Practitioner | 755 Knightsbridge Rd, Fairbanks, AK 99709-2477 | 2019-08-27 |
| 1942765052 | Jamie Marie Bourque | Nurse Practitioner | 1788 Yukon Drive, Fairbanks, AK 99775-5580 | 2019-02-02 |
| 1821588989 | Corrie Wilson | Nurse Practitioner | 1025 Barnette Street, Fairbanks, AK 99701 | 2018-05-15 |
| 1134667165 | Lauren Westrom | Nurse Practitioner | 1587 Drouin Rd, Fairbanks, AK 99709-5953 | 2017-02-10 |
| 1811356330 | Joseph Grimes | Nurse Practitioner | 132 Foran Cir, Fairbanks, AK 99712-2404 | 2016-02-11 |
| 1922482330 | Anna Fath | Nurse Practitioner | 5165 Palo Verde Ave, Fairbanks, AK 99709-3130 | 2015-07-15 |
| 1629407325 | Diane Louise Mitchell | Nurse Practitioner | 4650 Harvard Cir, Fairbanks, AK 99709 | 2013-11-04 |
| 1457490328 | Donna M Patrick | Nurse Practitioner | 612 N. Chandalar, Fairbanks, AK 99775-5580 | 2007-02-06 |
| 1841337334 | Nancy Prudence Bayer | Nurse Practitioner | 612 North Chandalar Ave, Fairbanks, AK 99775-5580 | 2007-01-31 |
| 1043243470 | Anne Marie Lilley | Nurse Practitioner | 1275 Sadler Way, #101, Fairbanks, AK 99701-3171 | 2006-07-09 |
| Find all providers in FAIRBANKS | ||||
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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.