MEDICARE: BEAIVI INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1336000116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAIVI INC

Provider Business Mailing Address
First Line	:	1542 CLEVELAND AVE
Second Line	:
City	:	LA GRANGE PARK
State	:	IL
Zip	:	60526-1308
Country	:	US
Telephone Number	:	847-616-8271
Fax Number	:

Provider Business Practice Location Address
First Line	:	1542 CLEVELAND AVE
Second Line	:
City	:	LA GRANGE PARK
State	:	IL
Zip	:	60526-1308
Country	:	US
Telephone Number	:	847-616-8271
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NICOLE NAGLICH
Credential	:	PMHNP, DNP
Telephone Number	:	847-420-1090

Provider Enumeration Date	:	11/20/2025
Last Update Date	:	11/20/2025

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