Provider Demographics
NPI:1043327992
Name:O'ROURKE, LOIS ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:ANNE
Last Name:O'ROURKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:973 OTTAWA AVE NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1431
Mailing Address - Country:US
Mailing Address - Phone:616-391-7752
Mailing Address - Fax:616-391-7733
Practice Address - Street 1:973 OTTAWA AVE NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1431
Practice Address - Country:US
Practice Address - Phone:616-391-7752
Practice Address - Fax:616-391-7733
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002679363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant