Provider Demographics
NPI:1114011327
Name:CHUCHLA, VICTORIA ELAINE
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ELAINE
Last Name:CHUCHLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 GULFSTREAM DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-6704
Mailing Address - Country:US
Mailing Address - Phone:252-335-6460
Mailing Address - Fax:252-335-6255
Practice Address - Street 1:IS COMDT # CG-1122
Practice Address - Street 2:U.S.COAST GUARD, 2100 2ND ST SW, SUITE 5314
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20593-0001
Practice Address - Country:US
Practice Address - Phone:252-335-6460
Practice Address - Fax:252-335-6255
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other