Healthcare Provider Details

I. General information

NPI: 1285582791
Provider Name (Legal Business Name): MAKENZIE ROSE FRISOLI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 COMMONWEALTH AVE STE 526
BOSTON MA
02215-2606
US

IV. Provider business mailing address

136 W ELM ST
PEMBROKE MA
02359-2111
US

V. Phone/Fax

Practice location:
  • Phone: 508-317-8302
  • Fax:
Mailing address:
  • Phone: 508-317-8302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN235034
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: