Healthcare Provider Details

I. General information

NPI: 1841295300
Provider Name (Legal Business Name): COLLEEN A HENSEL APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLLEEN A HENNING

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 28TH AVENUE DR SUITE 200
MOLINE IL
61265-5536
US

IV. Provider business mailing address

865 LINCOLN RD STE L10
BETTENDORF IA
52722-4159
US

V. Phone/Fax

Practice location:
  • Phone: 309-281-6000
  • Fax: 309-281-6009
Mailing address:
  • Phone: 563-355-9191
  • Fax: 563-355-3419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209001000
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA054401
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: