Provider Demographics
NPI:1023816931
Name:O'ROURKE, DOLORES ANN (MS, RD)
Entity type:Individual
Prefix:
First Name:DOLORES
Middle Name:ANN
Last Name:O'ROURKE
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:LOLA
Other - Middle Name:
Other - Last Name:O'ROURKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, RD
Mailing Address - Street 1:6529 NE MY WAY
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-4037
Mailing Address - Country:US
Mailing Address - Phone:206-842-5435
Mailing Address - Fax:
Practice Address - Street 1:6529 NE MY WAY
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-4037
Practice Address - Country:US
Practice Address - Phone:206-842-5435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA707045133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered