Healthcare Provider Details

I. General information

NPI: 1356276216
Provider Name (Legal Business Name): CAMILLE VAN ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 BOYLSTON ST
CHESTNUT HILL MA
02467-1700
US

IV. Provider business mailing address

213 MANCHESTER ST
MATTAPAN MA
02126-2825
US

V. Phone/Fax

Practice location:
  • Phone: 627-980-2103
  • Fax:
Mailing address:
  • Phone: 617-980-2103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2338899
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: