Provider Demographics
NPI:1164597092
Name:CHYKA, LISA M (CRNA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:CHYKA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:MCDONOUGH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 372
Mailing Address - Street 2:MASSACHUSETTS ANESTHESIA CORP.
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:
Practice Address - Street 1:50 STANDIFORD ST
Practice Address - Street 2:C/O MA ANESTHESIA CORP.
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:781-341-3966
Practice Address - Fax:781-341-8269
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA203845367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANA0887Medicare ID - Type Unspecified