Healthcare Provider Details

I. General information

NPI: 1184104853
Provider Name (Legal Business Name): ANDREA LYNN FARMER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 WALL ST
VALPARAISO IN
46383-2512
US

IV. Provider business mailing address

2354 SWEET BRIAR LN
VALPARAISO IN
46385-8099
US

V. Phone/Fax

Practice location:
  • Phone: 219-531-3500
  • Fax:
Mailing address:
  • Phone: 219-508-3392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number28127680A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: