Healthcare Provider Details

I. General information

NPI: 1235635657
Provider Name (Legal Business Name): MORGAN MAKO APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 LIBERTY SQ # 2681
BOSTON MA
02109-5800
US

IV. Provider business mailing address

6 LIBERTY SQ # 2681
BOSTON MA
02109-5800
US

V. Phone/Fax

Practice location:
  • Phone: 617-297-8085
  • Fax: 617-812-1689
Mailing address:
  • Phone: 617-297-8085
  • Fax: 617-812-1689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2312614
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11030223
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF343166
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: