Healthcare Provider Details

I. General information

NPI: 1427426568
Provider Name (Legal Business Name): ANNA LOUISE ROURKE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2015
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2841 LOMITA BLVD STE 100
TORRANCE CA
90505-5100
US

IV. Provider business mailing address

219 NEWPORT AVE APT 4
LONG BEACH CA
90803-5935
US

V. Phone/Fax

Practice location:
  • Phone: 310-257-0508
  • Fax: 310-325-8109
Mailing address:
  • Phone: 206-446-6769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number810389
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95003673
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: