Provider Demographics
NPI:1477267359
Name:O'ROURKE, SUSANNE (NP)
Entity Type:Individual
Prefix:MRS
First Name:SUSANNE
Middle Name:
Last Name:O'ROURKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:SUSANNE
Other - Middle Name:
Other - Last Name:VELASCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:56 CRESTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10707-2224
Mailing Address - Country:US
Mailing Address - Phone:914-960-3657
Mailing Address - Fax:
Practice Address - Street 1:55 PALMER AVE
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-3403
Practice Address - Country:US
Practice Address - Phone:914-960-3657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309732363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health