Provider Demographics
NPI:1275712291
Name:AMOUZGAR, KIMBERLY A (CRNA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:AMOUZGAR
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:AMOUZGOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
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:781-407-7713
Mailing Address - Fax:781-407-0998
Practice Address - Street 1:255 PLAIN DRIVE
Practice Address - Street 2:C/O MA ANESTHESIA CORP.
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072
Practice Address - Country:US
Practice Address - Phone:781-344-2325
Practice Address - Fax:781-341-8269
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA227274367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered