Provider Demographics
NPI:1740772169
Name:THOMSON, AMALIA JANE (CRNA)
Entity type:Individual
Prefix:
First Name:AMALIA
Middle Name:JANE
Last Name:THOMSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:AMALIA
Other - Middle Name:JANE
Other - Last Name:ZYCHOWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:508-334-3271
Practice Address - Fax:508-856-5911
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2276894367500000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110165904AMedicaid