Healthcare Provider Details

I. General information

NPI: 1164399127
Provider Name (Legal Business Name): OLIVIA RENE SORENSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

22511 SE MORRISON CT
GRESHAM OR
97030-2602
US

IV. Provider business mailing address

22511 SE MORRISON CT
GRESHAM OR
97030-2602
US

V. Phone/Fax

Practice location:
  • Phone: 971-227-0425
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10052293
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: