1841295300 NPI number — COLLEEN A HENSEL APN

Table of content: COLLEEN A HENSEL APN (NPI 1841295300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841295300 NPI number — COLLEEN A HENSEL APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENSEL
Provider First Name:
COLLEEN
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HENNING
Provider Other First Name:
COLLEEN
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841295300
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
865 LINCOLN RD
Provider Second Line Business Mailing Address:
STE L10
Provider Business Mailing Address City Name:
BETTENDORF
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52722-4159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-355-9191
Provider Business Mailing Address Fax Number:
563-355-3419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3900 28TH AVENUE DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
MOLINE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61265-5536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-281-6000
Provider Business Practice Location Address Fax Number:
309-281-6009
Provider Enumeration Date:
06/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  209001000 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: A054401 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 149294 . This is a "IOWA HEALTH SOLUTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 479700450 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 077674 . This is a "HEALTH ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4796890024 . This is a "DMERC" identifier . This identifiers is of the category "OTHER".
  • Identifier: IL0136 . This is a "JOHN DEERE HEALTH PLAN" identifier . This identifiers is of the category "OTHER".




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