Provider Demographics
NPI:1841295300
Name:HENSEL, COLLEEN A (APN)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:A
Last Name:HENSEL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:A
Other - Last Name:HENNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:865 LINCOLN RD
Mailing Address - Street 2:STE L10
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4159
Mailing Address - Country:US
Mailing Address - Phone:563-355-9191
Mailing Address - Fax:563-355-3419
Practice Address - Street 1:3900 28TH AVENUE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-5536
Practice Address - Country:US
Practice Address - Phone:309-281-6000
Practice Address - Fax:309-281-6009
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001000363LF0000X
IAA054401363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
149294OtherIOWA HEALTH SOLUTIONS
IL479700450Medicaid
077674OtherHEALTH ALLIANCE
4796890024OtherDMERC
IL0136OtherJOHN DEERE HEALTH PLAN
4796890024OtherDMERC
P01308Medicare UPIN
P01308Medicare UPIN