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General NPI Number Information
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NPI Number | 1164078788
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Entity Type | Individual
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Provider Name | LENA MARIE BEALE APRN
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Gender | Female
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Dates
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Enumeration Date | 08/11/2019
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Last Update Date | 08/11/2019
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Provider Practice Location Address
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Address Line | 2200 W TOUHY AVE
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City | CHICAGO
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State | IL
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Zip | 60645-3412
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Country | US
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Telephone | 773-751-1875
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Fax |
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Provider Business Mailing Address
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Address Line | 5727 N MANGO AVE FL 2
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City | CHICAGO
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State | IL
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Zip | 60646-6307
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Country | US
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Telephone | 815-878-0878
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209019801
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License Number State | IL
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