Provider Demographics
NPI:1578550661
Name:ROURKE, JOANNE M (NP)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:M
Last Name:ROURKE
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:8 MAHOGANY DRIVE
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:NY
Mailing Address - Zip Code:12189
Mailing Address - Country:US
Mailing Address - Phone:518-528-9887
Mailing Address - Fax:518-626-6606
Practice Address - Street 1:113 HOLLAND AVENUE, MAIL CODE 111-D
Practice Address - Street 2:STRATTON VA MEDICAL CENTER
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208
Practice Address - Country:US
Practice Address - Phone:518-626-6487
Practice Address - Fax:518-626-6606
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYF300814-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02211530Medicaid
NYP07558Medicare UPIN