Healthcare Provider Details

I. General information

NPI: 1942072434
Provider Name (Legal Business Name): MIA BIANCA BARKER DNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2023
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4580 WEAVER PKWY STE 102
WARRENVILLE IL
60555-3864
US

IV. Provider business mailing address

3823 W EDDY ST
CHICAGO IL
60618-5013
US

V. Phone/Fax

Practice location:
  • Phone: 630-839-9199
  • Fax:
Mailing address:
  • Phone: 773-372-2589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209.029401
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.450235
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: