Provider Demographics
NPI:1780875617
Name:KETCHUM, VICTORIA L (ATC)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:L
Last Name:KETCHUM
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 83442
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99708-3442
Mailing Address - Country:US
Mailing Address - Phone:907-474-4848
Mailing Address - Fax:
Practice Address - Street 1:E. COWLES
Practice Address - Street 2:FAIRBANKS MEMORIAL HOSPITAL
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99702
Practice Address - Country:US
Practice Address - Phone:907-456-6561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist