Provider Demographics
NPI:1164078788
Name:BEALE, LENA MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:MARIE
Last Name:BEALE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LENA
Other - Middle Name:MARIE
Other - Last Name:CROSSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5727 N MANGO AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-6307
Mailing Address - Country:US
Mailing Address - Phone:815-878-0878
Mailing Address - Fax:
Practice Address - Street 1:2200 W TOUHY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-3412
Practice Address - Country:US
Practice Address - Phone:773-751-1875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-11
Last Update Date:2019-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209019801363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily