Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Marisa Mackenzie

Individual provider Nurse Practitioner · NPI 1790505873

Marisa Mackenzie is a Nurse Practitioner in Portland, Oregon. Licensed in Oregon. Registered with an NPI since 2024.

Licensed in
OR
In the registry since
2024
Specialties on file
2

Practice location Address checks out

3181 SW Sam Jackson Park Rd
Portland, OR 97239-3011
Phone: (503) 494-5350
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatric Nurse Practitioner (primary) Taxonomy 363LP0200X · Licence 10032067 (OR)
Nurse Practitioner Taxonomy 363L00000X · Licence 10032067 (OR)

Record details

NPI number1790505873
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedOctober 14, 2024
Last updated in NPPESMarch 18, 2025
Certification dateMarch 18, 2025
Mailing address3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011

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