Provider Demographics
NPI:1982457107
Name:WEBSTER, DONNA JEAN (MSN, APNP,PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JEAN
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:MSN, APNP,PMHNP-BC
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:JEAN
Other - Last Name:BROESKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:N2503 STATE HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54451-8862
Mailing Address - Country:US
Mailing Address - Phone:715-965-0640
Mailing Address - Fax:
Practice Address - Street 1:N2503 STATE HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451-8862
Practice Address - Country:US
Practice Address - Phone:715-965-0640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1520833363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty