MEDICARE: ANGELA D BEAL

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	277001168	IL
2	363L00000X	Nurse Practitioner	209018494	IL
3	363LF0000X	Family Nurse Practitioner	277001168	IL
4	363LF0000X	Family Nurse Practitioner	209018494	IL
5	363LF0000X	Family Nurse Practitioner	1133284	TX

General Provider Information

NPI Number	:	1861965543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA D BEAL

Provider Business Mailing Address
First Line	:	2136 W 95TH ST STE 201
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-1000
Country	:	US
Telephone Number	:	708-765-9288
Fax Number	:	773-409-9381

Provider Business Practice Location Address
First Line	:	6633 BELLFORT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77087-6409
Country	:	US
Telephone Number	:	713-993-6425
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2019
Last Update Date	:	08/11/2025

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