Provider Demographics
NPI:1235209636
Name:MASSE, HENRI RAYMOND (GNP)
Entity Type:Individual
Prefix:MR
First Name:HENRI
Middle Name:RAYMOND
Last Name:MASSE
Suffix:
Gender:M
Credentials:GNP
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3554 ROUND BARN BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-0930
Mailing Address - Country:US
Mailing Address - Phone:707-571-3872
Mailing Address - Fax:707-571-3885
Practice Address - Street 1:3554 ROUND BARN BLVD STE 108
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-0930
Practice Address - Country:US
Practice Address - Phone:707-571-3872
Practice Address - Fax:707-571-3885
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5023363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ12597Medicare UPIN