Healthcare Provider Details

I. General information

NPI: 1396000360
Provider Name (Legal Business Name): MARY EVELYN SCHWENN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. MARY EVELYN KOZLOV

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 VALLEY VIEW DR
MOLINE IL
61265-6152
US

IV. Provider business mailing address

520 VALLEY VIEW DR
MOLINE IL
61265-6152
US

V. Phone/Fax

Practice location:
  • Phone: 309-762-3621
  • Fax: 309-762-3690
Mailing address:
  • Phone: 309-762-3621
  • Fax: 309-762-3690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.009737
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA098683
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: