Victoria Malloch Desalvo, ARNP
Individual provider Active NPI Nurse Practitioner · Brewster, WA
NPI 1174043384 · NPPES record last updated Jun 20, 2017
Key facts
- NPI
- 1174043384
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- AP60758226 (WA)
- Practice address
- 520 W Indian Ave
Brewster, WA 98812 - Phone
- (509) 689-2525
- Fax
- (509) 689-3247
- NPI assigned
- Jun 20, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Family Health Centers
Practice addresses (Care Compare)
520 W Indian Ave
Brewster, WA 98812-5003
Phone (509) 689-2525
Hospital & facility affiliations
- Mid Valley Hospital & Clinic
- Three Rivers Hospital
- Confluence Health Hospital
- Lake Chelan Community Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170901001365 | WA | Practitioner - Nurse Practitioner | 7416220009 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AP60758226 | WA | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Health Centers | Current |
Accepting new patients | |
| Family Health Centers | Current |
Accepting new patients |
Locations
525 Jay Ave
Brewster, WA 98812
Phone (509) 689-3455
1015 Columbia Ave
Bridgeport, WA 98813
Phone (509) 686-0603
1003 Koala Dr
Omak, WA 98841
Phone (509) 422-1913
Interoperability endpoints
- victoria.desalvo.1@19043.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | AP60758226 | WA | Yes |
Addresses
Primary practice location
520 W Indian Ave
Brewster, WA 98812
Mailing address
PO Box 1340
Okanogan, WA 98840-1340
Phone (509) 422-5700
Other providers in Brewster, WA
- Erin Cooley
- Tyler Ryan Copenhaver
- Tad Leon Davis
- Nicole Brooke Demarco
- Belinda Clare Denchfield
- Gregory Alan Dicamillo
- Gwendolyn Dick
- Douglas Okanogan County Fire District 15
- Mary Downey
- Dr Duane L Rana P S
All providers in Brewster, WA · Nurse Practitioner in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.