Healthcare Provider Details

I. General information

NPI: 1447607577
Provider Name (Legal Business Name): MELISSA WILLITZER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PARK RD
PORTLAND OR
97239-3011
US

IV. Provider business mailing address

1834 NE SCHUYLER ST
PORTLAND OR
97212-4553
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-7500
  • Fax:
Mailing address:
  • Phone: 503-793-3019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number184240
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: