Individual
DR. MARISA JANE WICKERATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1825 MAPLE ST, FOREST GROVE, OR 97116-1939
(503) 357-2136
Mailing address
1400 SW 5TH AVE STE 500, PORTLAND, OR 97201-5537
(503) 346-8021
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
MD61556041
WA
207Q00000X
Family Medicine Physician
Primary
MD221260
OR
Other
Enumeration date
03/22/2021
Last updated
10/23/2024
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