Provider Demographics
NPI:1619361417
Name:CRADDICK, VICTORIA (PHN)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:CRADDICK
Suffix:
Gender:F
Credentials:PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 W BARNETTE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4539
Mailing Address - Country:US
Mailing Address - Phone:907-451-1631
Mailing Address - Fax:907-451-1611
Practice Address - Street 1:1025 W BARNETTE ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4539
Practice Address - Country:US
Practice Address - Phone:907-451-1631
Practice Address - Fax:907-451-1611
Is Sole Proprietor?:No
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK11133163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse