Healthcare Provider Details

I. General information

NPI: 1235278854
Provider Name (Legal Business Name): KATHLEEN SHARON O'ROURKE CRNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 N WHITMAN ST
TACOMA WA
98407-1547
US

IV. Provider business mailing address

13610 NE 22ND ST
VANCOUVER WA
98684-6801
US

V. Phone/Fax

Practice location:
  • Phone: 253-759-3065
  • Fax: 253-759-2585
Mailing address:
  • Phone: 360-694-7211
  • Fax: 360-750-1124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN00064881
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: