Provider Demographics
NPI:1073662763
Name:WILBER, DONNA RIDLEY SR (PSYCHIATRIC MENTAL H)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:RIDLEY
Last Name:WILBER
Suffix:SR
Gender:F
Credentials:PSYCHIATRIC MENTAL H
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 BELKNAP HILL RD
Mailing Address - Street 2:
Mailing Address - City:BRANCHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14418-9510
Mailing Address - Country:US
Mailing Address - Phone:315-759-1085
Mailing Address - Fax:
Practice Address - Street 1:4020 BELKNAP HILL RD
Practice Address - Street 2:
Practice Address - City:BRANCHPORT
Practice Address - State:NY
Practice Address - Zip Code:14418-9510
Practice Address - Country:US
Practice Address - Phone:315-759-1085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF4008421363L00000X
NYF400342363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner