Donna Ridley Wilber Sr., PSYCHIATRIC MENTAL H
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Branchport, NY
NPI 1073662763 · NPPES record last updated May 1, 2024
Key facts
- NPI
- 1073662763
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- F400342 (NY)
- Practice address
- 4020 Belknap Hill Rd
Branchport, NY 14418-9510 - Phone
- (315) 759-1085
- NPI assigned
- Jan 10, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- University of Rochester School of Medicine and Dentistry, 2004
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
4020 Belknap Hill Rd
Branchport, NY 14418-9510
Phone (315) 759-1798
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- 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 |
|---|---|---|---|---|
| I20161005000139 | NY | Practitioner - Nurse Practitioner | 5597053678 | Practice locations: Branchport, NY |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F4008421 | NY | MD | Nurse Practitioner |
| F400342 | NY | MD | Psychiatric/Mental Health Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | F4008421 | NY | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | F400342 | NY | Yes |
Addresses
Primary practice location
4020 Belknap Hill Rd
Branchport, NY 14418-9510
Mailing address
4020 Belknap Hill Rd
Branchport, NY 14418-9510
Phone (315) 759-1085
Other providers in Branchport, NY
All providers in Branchport, NY · Psychiatric/Mental Health Nurse Practitioner in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 1, 2024. 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.