Healthcare Provider Details

I. General information

NPI: 1700769338
Provider Name (Legal Business Name): EILEEN A FARMER APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2443 WARRENVILLE RD STE 500
LISLE IL
60532-4356
US

IV. Provider business mailing address

1100 CENTRAL AVE STE F
WILMETTE IL
60091-2666
US

V. Phone/Fax

Practice location:
  • Phone: 224-463-1071
  • Fax:
Mailing address:
  • Phone: 312-600-8533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.032631
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.032631
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: