Provider Demographics
NPI:1427159110
Name:HEPBURN, DONNA (NP)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:
Last Name:HEPBURN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CARRIAGE HOUSE LN
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-3919
Mailing Address - Country:US
Mailing Address - Phone:914-241-0758
Mailing Address - Fax:914-242-5152
Practice Address - Street 1:333 ADAMS ST
Practice Address - Street 2:
Practice Address - City:BEDFORD HILLS
Practice Address - State:NY
Practice Address - Zip Code:10507-2001
Practice Address - Country:US
Practice Address - Phone:914-241-5158
Practice Address - Fax:914-242-5152
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTR53973363LP0808X
NYF400728-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health