Provider Demographics
NPI:1033733027
Name:OKOLI, DORIS (DNP, MSN, RN, MPH)
Entity Type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:
Last Name:OKOLI
Suffix:
Gender:F
Credentials:DNP, MSN, RN, MPH
Other - Prefix:
Other - First Name:DORIS
Other - Middle Name:IFEOMA
Other - Last Name:AGU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, MSN, RN, MPH
Mailing Address - Street 1:17703 SW HEATHERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-7122
Mailing Address - Country:US
Mailing Address - Phone:562-221-1114
Mailing Address - Fax:
Practice Address - Street 1:2600 CENTER ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2682
Practice Address - Country:US
Practice Address - Phone:503-905-9209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202004180NP-PP363LP0808X
CA95015565363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health