Nurse Practitioner Statement - Oregon 2026

1. Click ‘Get Form’ to open the Nurse Practitioner Statement in the editor.
2. Begin by entering your license number in the designated field. This is crucial for verifying your credentials.
3. Review the Nurse Practitioner’s Handbook and the informational packet provided. Acknowledge your understanding by signing in the signature field.
4. Fill in the date of signing, ensuring it reflects when you completed the form.
5. Provide your full name as it appears on your nursing license, followed by your primary business address.
6. Enter your contact information, including phone number, fax number, and business email for any follow-up communications.
7. If available, include your FEIN and NPI numbers in their respective fields to facilitate processing.
8. Once all fields are completed, review for accuracy before submitting. You can easily export or print directly from our platform.

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