Wickerath, Marisa Jane

Wickerath, Marisa Jane is an individual health care provider with primary practice located at 1825 Maple St , Forest Grove OR 97116-1939. She recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Emergency Medicine, Student, Health Care / Student in an Organized Health Care Education/Training Program. Allopathic & Osteopathic Physicians / Family Medicine is her primary health care specialty. Wickerath, Marisa Jane can be contacted via phone (503) 357-2136.

Contact Information

Primary practice address
1825 Maple St Forest Grove OR 97116-1939
Phone: (503) 357-2136
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD221260 Oregon
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X MD61556041 Washington
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X

Profile Details

NPI number 1962088641
LBN Legal business name Wickerath, Marisa Jane
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 22nd, 2021
Last updated Jul 1st, 2024 - about 2 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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