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General NPI Number Information
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NPI Number | 1376838045
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Entity Type | Individual
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Provider Name | ANGELA JADE BEAVERS MD
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Gender | Female
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Dates
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Enumeration Date | 06/10/2011
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Last Update Date | 12/19/2025
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Provider Practice Location Address
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Address Line | 8200 DODGE ST
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City | OMAHA
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State | NE
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Zip | 68114-4113
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Country | US
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Telephone | 402-250-9233
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Fax |
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Provider Business Mailing Address
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Address Line | 1509 N 129TH AVENUE CIR
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City | OMAHA
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State | NE
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Zip | 68154-1072
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Country | US
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Telephone | 402-250-9233
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 6650
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number | 28901
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | SD
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Taxonomy #4
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | Q7531
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License Number State | TX
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