Provider Demographics
NPI:1174908826
Name:YAMAMOTO, CARRIE LYNN (APRN)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNN
Last Name:YAMAMOTO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2345 E PRATER WAY STE 207
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-9634
Mailing Address - Country:US
Mailing Address - Phone:775-387-1616
Mailing Address - Fax:775-387-1777
Practice Address - Street 1:2385 E PRATER WAY STE 302
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-9638
Practice Address - Country:US
Practice Address - Phone:775-387-1616
Practice Address - Fax:775-387-1777
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2020-07-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NVAPRN001927363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1174908826Medicaid