Provider Demographics
NPI:1457415069
Name:O'ROURKE, REBECCA J (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:J
Last Name:O'ROURKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:JACKSON
Other - Last Name:SCHEITERLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4919 W CRAIG RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-2730
Mailing Address - Country:US
Mailing Address - Phone:725-220-8706
Mailing Address - Fax:833-749-0366
Practice Address - Street 1:4919 W CRAIG RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-2730
Practice Address - Country:US
Practice Address - Phone:725-220-8706
Practice Address - Fax:833-749-0366
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV18026207Q00000X
HIMD16304174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI694803Medicaid
NV18026OtherNV STATE LICENSE
NV1457415069Medicaid