Active NPI
Victoria Anne Wallace, ANP
- Family Nurse Practitioner
- Fairbanks, AK
National Provider Identifier
1295769859
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 713
- Practice address
- 1931 Eagan Ave
Fairbanks Correctional Center
Fairbanks, AK 99701-5703 - Phone
- (907) 458-6700
- NPI assigned
- Jul 10, 2006
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 713 | AK | Primary |
Addresses
Primary practice location
1931 Eagan Ave
Fairbanks Correctional Center
Fairbanks, AK 99701-5703
Mailing address
1931 Eagan Ave
Fairbanks Correctional Center
Fairbanks, AK 99701-5703
Phone (907) 458-6700
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NP0254 | Medicaid | AK | |
| NP02541 | Medicaid | AK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gustavus Community Clinic Inc | Family | Past | Accepting new patients |
| Southeast Alaska Regional Health Consortium | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Nurse Practitioner
- Gustavus, AK
- NPI 1548281215
-
- Clinic/Center
- Gustavus, AK
- NPI 1649716226
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1295769859",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1931 EAGAN AVE",
"address_2": "FAIRBANKS CORRECTIONAL CENTER",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997015703",
"telephone_number": "907-458-6700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1931 EAGAN AVE",
"address_2": "FAIRBANKS CORRECTIONAL CENTER",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997015703",
"telephone_number": "907-458-6700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "VICTORIA",
"middle_name": "ANNE",
"name_prefix": "Mrs.",
"credential": "ANP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-10",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "AK",
"license": "713",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "NP0254",
"state": "AK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "NP02541",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairbanks, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.