Basic Information
| Provider Information | |||||||||
| NPI: | 1841295300 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HENSEL | ||||||||
| FirstName: | COLLEEN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | APN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HENNING | ||||||||
| OtherFirstName: | COLLEEN | ||||||||
| OtherMiddleName: | A | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 865 LINCOLN RD | ||||||||
| Address2: | STE L10 | ||||||||
| City: | BETTENDORF | ||||||||
| State: | IA | ||||||||
| PostalCode: | 527224159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5633559191 | ||||||||
| FaxNumber: | 5633553419 | ||||||||
| Practice Location | |||||||||
| Address1: | 3900 28TH AVENUE DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MOLINE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 612655536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3092816000 | ||||||||
| FaxNumber: | 3092816009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2005 | ||||||||
| LastUpdateDate: | 04/29/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 209001000 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | A054401 | IA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 149294 | 01 | IOWA HEALTH SOLUTIONS | OTHER | 479700450 | 05 | IL | MEDICAID | 077674 | 01 | HEALTH ALLIANCE | OTHER | 4796890024 | 01 | DMERC | OTHER | IL0136 | 01 | JOHN DEERE HEALTH PLAN | OTHER |