Provider Demographics
NPI:1366172934
Name:SUNDQUIST, VICTORIA KRISTIN (CNM)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:KRISTIN
Last Name:SUNDQUIST
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 VIRGINIA DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8817
Mailing Address - Country:US
Mailing Address - Phone:505-730-6316
Mailing Address - Fax:
Practice Address - Street 1:2620 E PROSPECT RD STE 160
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-9098
Practice Address - Country:US
Practice Address - Phone:970-221-4977
Practice Address - Fax:970-221-4980
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-15
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0106683367A00000X, 163WX0003X, 367A00000X
CO0997655367A00000X, 163WX0003X, 367A00000X
COAPN.0997655-CNM367A00000X
NM873367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO236Medicaid
NM47653019Medicaid