Healthcare Provider Details

I. General information

NPI: 1578550661
Provider Name (Legal Business Name): JOANNE M ROURKE N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 HOLLAND AVENUE, MAIL CODE 111-D STRATTON VA MEDICAL CENTER
ALBANY NY
12208
US

IV. Provider business mailing address

8 MAHOGANY DRIVE
WATERVLIET NY
12189
US

V. Phone/Fax

Practice location:
  • Phone: 518-626-6487
  • Fax: 518-626-6606
Mailing address:
  • Phone: 518-528-9887
  • Fax: 518-626-6606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF300814-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: