Healthcare Provider Details

I. General information

NPI: 1861319600
Provider Name (Legal Business Name): HALEY LYNN PUFFENBARGER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17901 OWENS RD
MAPLE PARK IL
60151-5225
US

IV. Provider business mailing address

17901 OWENS RD
MAPLE PARK IL
60151-5225
US

V. Phone/Fax

Practice location:
  • Phone: 708-548-4912
  • Fax:
Mailing address:
  • Phone: 708-548-4912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.522210
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: