Individual provider · Type 1 NPI
Marisa Mackenzie
Pediatric Nurse Practitioner · Portland, OR
NPI number
1790505873
Active
Practice location
3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner | 363L00000X | 10032067 (OR) |
| Pediatric Nurse Practitioner Primary | 363LP0200X | 10032067 (OR) |
Pediatric Nurse Practitioner: Definition to come...
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About NPI 1790505873
Marisa Mackenzie's National Provider Identifier is 1790505873, issued on Oct 14, 2024. The primary taxonomy on file is Pediatric Nurse Practitioner (363LP0200X), and the practice location is in Portland, OR. The record was last updated on Mar 18, 2025.