Healthcare Provider Details

I. General information

NPI: 1295378180
Provider Name (Legal Business Name): CHELSEA A ROURKE RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4815 LIBERTY AVE STE 250
PITTSBURGH PA
15224-2156
US

IV. Provider business mailing address

4815 LIBERTY AVE STE 250
PITTSBURGH PA
15224-2156
US

V. Phone/Fax

Practice location:
  • Phone: 724-941-7490
  • Fax: 724-941-5231
Mailing address:
  • Phone: 724-941-7490
  • Fax: 724-941-5231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN004635
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: