Provider Demographics
NPI:1891079588
Name:BALDASARRE, VICTORIA ANN (APRN)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:ANN
Last Name:BALDASARRE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 NORTHERN BLVD
Mailing Address - Street 2:SUITE 15B
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031-2336
Mailing Address - Country:US
Mailing Address - Phone:603-785-6260
Mailing Address - Fax:
Practice Address - Street 1:10 NORTHERN BLVD
Practice Address - Street 2:SUITE 15B
Practice Address - City:AMHERST
Practice Address - State:NH
Practice Address - Zip Code:03031-2336
Practice Address - Country:US
Practice Address - Phone:603-785-6260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-29
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH060080-23363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health