Healthcare Provider Details

I. General information

NPI: 1194725499
Provider Name (Legal Business Name): VICTORIA MARIA VALDESUSO PSYD, APRN,PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N WILLSON AVE STE 602F-1
BOZEMAN MT
59715-3551
US

IV. Provider business mailing address

2412 PAR CT APT D
BOZEMAN MT
59715-1514
US

V. Phone/Fax

Practice location:
  • Phone: 406-404-5451
  • Fax:
Mailing address:
  • Phone: 406-404-5451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP2124372
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP2124372
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number105016
License Number StateMT
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY6404
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: