Healthcare Provider Details

I. General information

NPI: 1649469164
Provider Name (Legal Business Name): THEREASE MARIE FOLEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 NW COUNCIL DR STE 125
GRESHAM OR
97030-3794
US

IV. Provider business mailing address

525 3RD ST STE 304
LAKE OSWEGO OR
97034-3082
US

V. Phone/Fax

Practice location:
  • Phone: 503-665-8176
  • Fax: 503-665-8178
Mailing address:
  • Phone: 503-783-6907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number201706920NP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number129276
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: