Provider Demographics
NPI:1114752524
Name:MASUTOMI, CARYN CHANEL (APRN)
Entity type:Individual
Prefix:
First Name:CARYN
Middle Name:CHANEL
Last Name:MASUTOMI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9480 DOUBLE DIAMOND PKWY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-5845
Mailing Address - Country:US
Mailing Address - Phone:775-786-1600
Mailing Address - Fax:
Practice Address - Street 1:9480 DOUBLE DIAMOND PKWY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5845
Practice Address - Country:US
Practice Address - Phone:775-786-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV882463363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily