Healthcare Provider Details

I. General information

NPI: 1033733027
Provider Name (Legal Business Name): DORIS OKOLI DNP, MSN, MPH, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DORIS IFEOMA AGU DNP, MSN, RN, MPH

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5441 S MACADAM AVE STE A
PORTLAND OR
97239-6106
US

IV. Provider business mailing address

5441 S MACADAM AVE STE A
PORTLAND OR
97239-6106
US

V. Phone/Fax

Practice location:
  • Phone: 503-922-1818
  • Fax: 503-922-1238
Mailing address:
  • Phone:
  • Fax: 503-922-1238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number202004180NP-PP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95015565
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: