MARISA JANE WICKERATH

FOREST GROVE, OR
NPI1962088641
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy207Q00000X Family Medicine
(Licence: OR  MD221260)
Additional Taxonomies207P00000X Emergency Medicine
(Licence: WA  MD61556041)
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2021-03-22
Last Update Date2024-07-01
Business Address
Dr. MARISA JANE WICKERATH MD
1825 MAPLE ST
FOREST GROVE, OR 97116-1939
Phone number: 503-357-2136
Mailing Address
Dr. MARISA JANE WICKERATH MD
3054 169TH AVE NE
BELLEVUE, WA 98008-2035
Phone number: 509-899-2377