Dr. Marisa Jane Wickerath, MD
Family Medicine in Portland, OR. Individual provider (NPI-1).
NPI number1962088641
StatusActive
Last updated in NPPESOct 15, 2026
Details
- NPI
- 1962088641
- Entity type
- Individual (NPI-1)
- Name
- Dr. Marisa Jane Wickerath
- Credential
- MD
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Mar 22, 2021
- Certification date
- Oct 15, 2026
- Last updated
- Oct 15, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | MD221260 | OR | Yes |
Practice location
3181 Sw Sam Jackson Park RdPortland, OR 97239-3011
Phone 503-494-3427 · Fax 503-494-3457
Mailing address
1400 Sw 5th Ave Ste 500Portland, OR 97201-5537
Fax 503-346-8021
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