Individual
MARISA MACKENZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-5350
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-5350
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
10032067
OR
363LP0200X
Pediatric Nurse Practitioner
Primary
10032067
OR
Other
Enumeration date
10/14/2024
Last updated
03/18/2025
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