Provider Demographics
NPI:1831460666
Name:FARMER, ANNA MARIE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:MARIE
Last Name:FARMER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 75TH ST
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-2325
Mailing Address - Country:US
Mailing Address - Phone:779-236-4094
Mailing Address - Fax:779-236-4094
Practice Address - Street 1:2070 N IL-50
Practice Address - Street 2:#500
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914
Practice Address - Country:US
Practice Address - Phone:779-236-4094
Practice Address - Fax:779-236-4094
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003852A363LF0000X
IL209.032491363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201065130Medicaid