Provider Demographics
NPI:1699905844
Name:KAMEN, ELINA (ACNP-BC)
Entity type:Individual
Prefix:
First Name:ELINA
Middle Name:
Last Name:KAMEN
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HOWE RD
Mailing Address - Street 2:
Mailing Address - City:NAHANT
Mailing Address - State:MA
Mailing Address - Zip Code:01908-1117
Mailing Address - Country:US
Mailing Address - Phone:781-598-8335
Mailing Address - Fax:
Practice Address - Street 1:271 NAHANT RD
Practice Address - Street 2:
Practice Address - City:NAHANT
Practice Address - State:MA
Practice Address - Zip Code:01908-1341
Practice Address - Country:US
Practice Address - Phone:617-943-9235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN230838363L00000X
MA230838363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1699905844Medicaid