Healthcare Provider Details

I. General information

NPI: 1326379462
Provider Name (Legal Business Name): ANNA OROURKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2010
Last Update Date: 01/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14500 BUSTLETON AVE STE 1-A
PHILADELPHIA PA
19116-1188
US

IV. Provider business mailing address

14500 BUSTLETON AVE STE 1-A
PHILADELPHIA PA
19116-1188
US

V. Phone/Fax

Practice location:
  • Phone: 215-613-6523
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: