1669457941 NPI number — MS. DONNA C WEBBER APRN

Table of content: MS. DONNA C WEBBER APRN (NPI 1669457941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669457941 NPI number — MS. DONNA C WEBBER APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEBBER
Provider First Name:
DONNA
Provider Middle Name:
C
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669457941
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
09/26/2023
NPI Reactivation Date:
10/17/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16 N ELM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06042-3226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-550-0487
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16 N ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06042-3226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-550-0487
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WP0808X , with the licence number:  E34122 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP0809X , with the licence number: 000591 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 061380466 . This is a "PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 142857 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7260046 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: IP341658 . This is a "MAGELLAN CTCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: O43443956 . This is a "HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061380466 . This is a "N" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1158BILLJPA . This is a "CASE MANAGEMENT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2125052 . This is a "CIGNA MCC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 282907 . This is a "NETWORK INC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 241246000 . This is a "MAGELLAN MBC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 282907 . This is a "HORIZON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 400000591CT03 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 004167096 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 061380466 . This is a "HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 175509000 . This is a "MASSACHUSSETTES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061380466 . This is a "HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 24124600 . This is a "MAGELLAN AETNA" identifier . This identifiers is of the category "OTHER".




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