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1073662763 NPI number — DONNA RIDLEY WILBER SR. PSYCHIATRIC MENTAL H

NPI Number: 1073662763
Health Care Provider/Practitioner: DONNA RIDLEY WILBER SR. PSYCHIATRIC MENTAL H

Information about “1073662763” NPI (DONNA RIDLEY WILBER SR. PSYCHIATRIC MENTAL H) exists in 1073662763 in HTML format HTML  |  1073662763 in plain Text format TXT  |  1073662763 in PDF (Portable Document Format) PDF  |  1073662763 in an XML format XML  formats.

NPI Number : 1073662763 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1073662763",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WILBER",
    "FirstName": "DONNA",
    "MiddleName": "RIDLEY",
    "NamePrefix": null,
    "NameSuffix": "SR.",
    "Credential": "PSYCHIATRIC MENTAL H",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4020 BELKNAP HILL RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BRANCHPORT",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "14418-9510",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "315-759-1085",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4020 BELKNAP HILL RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BRANCHPORT",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "14418-9510",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "315-759-1085",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/10/2007",
    "LastUpdateDate": "05/01/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": "F4008421",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LP0808X",
          "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
          "LicenseNumber": "F400342",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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