Provider Demographics
NPI:1396077897
Name:MANN, VICTORIA (RN)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:RN
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 69
Mailing Address - Street 2:
Mailing Address - City:KLAWOCK
Mailing Address - State:AK
Mailing Address - Zip Code:99925-0069
Mailing Address - Country:US
Mailing Address - Phone:907-755-4800
Mailing Address - Fax:907-755-4806
Practice Address - Street 1:13004 KLAWOCK HOLLIS HIGHWAY
Practice Address - Street 2:
Practice Address - City:KLAWOCK
Practice Address - State:AK
Practice Address - Zip Code:99925-0069
Practice Address - Country:US
Practice Address - Phone:907-755-4800
Practice Address - Fax:907-755-4806
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK23298163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse