Provider Demographics
NPI:1346581741
Name:CAMILLO, MEAGHAN ELIZABETH (NP)
Entity Type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:ELIZABETH
Last Name:CAMILLO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MEAGHAN
Other - Middle Name:
Other - Last Name:AHERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:720 HARRISON AVE
Mailing Address - Street 2:DOB 503
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:725 ALBANY STREET
Practice Address - Street 2:SHAPIRO 9, B AND C
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-414-4290
Practice Address - Fax:617-414-4285
Is Sole Proprietor?:No
Enumeration Date:2013-03-09
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2267993363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care