Provider Demographics
NPI:1942072434
Name:BARKER, MIA BIANCA (PMHNP)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:BIANCA
Last Name:BARKER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3927 W BELDEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2207
Mailing Address - Country:US
Mailing Address - Phone:773-372-2589
Mailing Address - Fax:
Practice Address - Street 1:4580 WEAVER PKWY STE 102
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-3864
Practice Address - Country:US
Practice Address - Phone:630-839-9199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-27
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.450235163W00000X
IL209.029401363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse