Healthcare Provider Details

I. General information

NPI: 1275712291
Provider Name (Legal Business Name): KIMBERLY A AMOUZGAR CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY A AMOUZGOR CRNA

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 PLAIN DRIVE C/O MA ANESTHESIA CORP.
STOUGHTON MA
02072
US

IV. Provider business mailing address

PO BOX 372 MASSACHUSETTS ANESTHESIA CORP.
STOUGHTON MA
02072
US

V. Phone/Fax

Practice location:
  • Phone: 781-344-2325
  • Fax: 781-341-8269
Mailing address:
  • Phone: 781-407-7713
  • Fax: 781-407-0998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number227274
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: