Provider Demographics
NPI:1245310937
Name:THOMAS, KIM ELAINE (CRNA)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:ELAINE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 HEMLOCK DR
Mailing Address - Street 2:
Mailing Address - City:LUNENBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01462-1147
Mailing Address - Country:US
Mailing Address - Phone:978-582-3384
Mailing Address - Fax:978-582-3384
Practice Address - Street 1:157 UNION ST
Practice Address - Street 2:DEPT. OF ANESTHESIA
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-1228
Practice Address - Country:US
Practice Address - Phone:978-857-9582
Practice Address - Fax:978-582-3384
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209081367500000X
NH0430192311367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANA0960Medicare ID - Type Unspecified