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 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-4422
Mailing Address - Fax:319-384-8492
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-4422
Practice Address - Fax:319-384-8492
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA102023363L00000X, 163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WX0200XNursing Service ProvidersRegistered NurseOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA500011032OtherRAILROAD MEDICARE
IA5713Medicare ID - Type Unspecified
IAS93640Medicare UPIN