Provider Demographics
NPI:1912309162
Name:ROURKE, THERESA (CRNP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:ROURKE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 UNIVERSITY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1873
Mailing Address - Country:US
Mailing Address - Phone:215-710-7037
Mailing Address - Fax:215-710-5181
Practice Address - Street 1:1205 LANGHRN NWTWN RD STE 403
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:215-710-4460
Practice Address - Fax:215-710-4465
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP014124363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health