Provider Demographics
NPI:1508841289
Name:MOHR, COLLEEN M (ARNP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:MOHR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:M
Other - Last Name:NEMICKAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:701 10TH ST SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-1251
Mailing Address - Country:US
Mailing Address - Phone:319-398-6105
Mailing Address - Fax:319-398-6509
Practice Address - Street 1:701 10TH ST SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-1251
Practice Address - Country:US
Practice Address - Phone:319-398-6860
Practice Address - Fax:319-398-6509
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA102023363LF0000X, 163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WX0200XNursing Service ProvidersRegistered NurseOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA500011032OtherRAILROAD MEDICARE
IA5713Medicare ID - Type Unspecified
IAS93640Medicare UPIN