Healthcare Provider Details

I. General information

NPI: 1164078788
Provider Name (Legal Business Name): LENA MARIE BEALE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LENA MARIE CROSSMAN

II. Dates (important events)

Enumeration Date: 08/11/2019
Last Update Date: 08/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 W TOUHY AVE
CHICAGO IL
60645-3412
US

IV. Provider business mailing address

5727 N MANGO AVE FL 2
CHICAGO IL
60646-6307
US

V. Phone/Fax

Practice location:
  • Phone: 773-751-1875
  • Fax:
Mailing address:
  • Phone: 815-878-0878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209019801
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: