Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 71002948A | IN |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 71002948A | IN |
NPI | 1336377670 |
---|---|
Provider Name | Nikki L O'rourke |
First Address | Indianapolis, IN 46205-1381 |
Second Address | Indianapolis, IN 46205-1381 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2009 |
Last Update Date | 08/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201108760 | (05) | IN |