Provider Demographics
NPI:1629169461
Name:ROURKE, AMY ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:AMY
Middle Name:ELIZABETH
Last Name:ROURKE
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:110 FRANCIS ST
Mailing Address - Street 2:SUITE 8E
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5501
Mailing Address - Country:US
Mailing Address - Phone:617-632-1056
Mailing Address - Fax:617-632-1065
Practice Address - Street 1:110 FRANCIS ST
Practice Address - Street 2:SUITE 8E
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5501
Practice Address - Country:US
Practice Address - Phone:617-632-1056
Practice Address - Fax:617-632-1065
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2011-04-14
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Provider Licenses
StateLicense IDTaxonomies
MA1730363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant