Provider Demographics
NPI:1194070466
Name:BOURKE, ANDREA (RPA-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:BOURKE
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2549
Mailing Address - Country:US
Mailing Address - Phone:603-742-5556
Mailing Address - Fax:
Practice Address - Street 1:1C COMMONS DR UNIT 16
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3441
Practice Address - Country:US
Practice Address - Phone:603-965-3551
Practice Address - Fax:603-818-8374
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015768363AM0700X
CT5643363AM0700X
NH1660363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical