Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 202004180NP-PP | OR |
NPI | 1033733027 |
---|---|
Provider Name | Mrs. Doris Okoli |
First Address | Sherwood, OR 97140-7122 |
Second Address | Salem, OR 97301-2682 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2020 |
Last Update Date | 04/06/2020 |