Healthcare Provider Details

I. General information

NPI: 1831045459
Provider Name (Legal Business Name): ALLISON DAGG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

17 MIDDLE ST
BOSTON MA
02127-2767
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-7970
  • Fax:
Mailing address:
  • Phone: 617-678-9387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number6AGX51
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: