Provider Demographics
NPI:1023149465
Name:O'ROURKE, ROBIN (RN)
Entity type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:
Last Name:O'ROURKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15836 W CROCUS DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-6248
Mailing Address - Country:US
Mailing Address - Phone:623-594-5442
Mailing Address - Fax:
Practice Address - Street 1:14898 W ACOMA DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-5443
Practice Address - Country:US
Practice Address - Phone:623-523-8340
Practice Address - Fax:623-523-8311
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN074122163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ856346Medicare ID - Type UnspecifiedPROVIDER NUMBER