Provider Demographics
NPI:1154743540
Name:KOLWEY, JENNIFER (ARNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KOLWEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:KOLWEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:3319 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2125
Mailing Address - Country:US
Mailing Address - Phone:563-359-1716
Mailing Address - Fax:563-359-4634
Practice Address - Street 1:3319 SPRING ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2125
Practice Address - Country:US
Practice Address - Phone:563-359-1716
Practice Address - Fax:563-359-4634
Is Sole Proprietor?:No
Enumeration Date:2014-01-20
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA102010363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1346229192OtherUROLOGICAL ASSOCIATES PC