Provider Demographics
NPI:1407391212
Name:BEAL, DAVENA JANEEN (PMH-NP)
Entity Type:Individual
Prefix:MS
First Name:DAVENA
Middle Name:JANEEN
Last Name:BEAL
Suffix:
Gender:F
Credentials:PMH-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5747 W WARWICK AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-2658
Mailing Address - Country:US
Mailing Address - Phone:773-332-7145
Mailing Address - Fax:
Practice Address - Street 1:2340 S HIGHLAND AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5371
Practice Address - Country:US
Practice Address - Phone:630-261-1210
Practice Address - Fax:630-261-1211
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.015353363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health