=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376818880
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARYLOU O'ROURKE R.N.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2012
-----------------------------------------------------
Last Update Date | 03/16/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11436 202ND ST PS811Q@PS822
-----------------------------------------------------
City | SAINT ALBANS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11412-2813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-217-8001
-----------------------------------------------------
Fax | 718-464-6690
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45 MIDWOOD RD
-----------------------------------------------------
City | ROCKVILLE CENTRE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11570-2019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WS0200X
-----------------------------------------------------
Taxonomy Name | School Registered Nurse
-----------------------------------------------------
License Number | 416754-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------