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General NPI Number Information
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NPI Number | 1033733027
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Entity Type | Individual
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Provider Name | DORIS IFEOMA AGU DNP, MSN, MPH, PMHNP
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Gender | Female
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Dates
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Enumeration Date | 06/04/2020
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 5441 S MACADAM AVE STE A
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City | PORTLAND
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State | OR
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Zip | 97239-6106
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Country | US
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Telephone | 503-922-1818
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Fax | 503-922-1238
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Provider Business Mailing Address
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Address Line | 5441 S MACADAM AVE STE A
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City | PORTLAND
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State | OR
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Zip | 97239-6106
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Country | US
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Telephone |
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Fax | 503-922-1238
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 202004180NP-PP
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95015565
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License Number State | CA
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