Provider Demographics
NPI:1194725499
Name:VALDESUSO, VICTORIA MARIA (PSYD, APRN,PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:MARIA
Last Name:VALDESUSO
Suffix:
Gender:F
Credentials:PSYD, APRN,PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 PAR CT APT D
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-1514
Mailing Address - Country:US
Mailing Address - Phone:406-404-5451
Mailing Address - Fax:
Practice Address - Street 1:300 N WILLSON AVE STE 602F-1
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3551
Practice Address - Country:US
Practice Address - Phone:406-404-5451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6404103TC0700X
FLARNP2124372363L00000X, 363LP0808X
MT105016363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54817Medicare ID - Type Unspecified