Provider Demographics
NPI:1770984841
Name:DORSEY, REBECCA (PMHNP, FNP, ENP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:DORSEY
Suffix:
Gender:F
Credentials:PMHNP, FNP, ENP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:945 COLUMBIA ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-7205
Mailing Address - Country:US
Mailing Address - Phone:503-707-1950
Mailing Address - Fax:855-461-3306
Practice Address - Street 1:945 COLUMBIA ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-7205
Practice Address - Country:US
Practice Address - Phone:503-707-1950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201607336NP-PP363LF0000X
OR201406327NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily