MEDICARE: A BEAUTIFUL MIND, 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	:	1598325698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A BEAUTIFUL MIND, INC

Provider Business Mailing Address
First Line	:	805 CENTURY DR STE 5
Second Line	:
City	:	DUBUQUE
State	:	IA
Zip	:	52002-3771
Country	:	US
Telephone Number	:	563-599-6991
Fax Number	:

Provider Business Practice Location Address
First Line	:	805 CENTURY DR STE 5
Second Line	:
City	:	DUBUQUE
State	:	IA
Zip	:	52002-3771
Country	:	US
Telephone Number	:	563-599-6991
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	MS. EARLENE M ANGELL
Credential	:	ARNP
Telephone Number	:	563-538-0550

Provider Enumeration Date	:	06/19/2019
Last Update Date	:	07/31/2019

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