Provider Demographics
NPI:1841499415
Name:ROURKE, DOROTHEA M (RD)
Entity type:Individual
Prefix:MS
First Name:DOROTHEA
Middle Name:M
Last Name:ROURKE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 PIPER RD
Mailing Address - Street 2:
Mailing Address - City:ASHBY
Mailing Address - State:MA
Mailing Address - Zip Code:01431-2057
Mailing Address - Country:US
Mailing Address - Phone:978-501-6419
Mailing Address - Fax:
Practice Address - Street 1:192 PIPER RD
Practice Address - Street 2:
Practice Address - City:ASHBY
Practice Address - State:MA
Practice Address - Zip Code:01431-2057
Practice Address - Country:US
Practice Address - Phone:978-501-6419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA967133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered