Provider Demographics
NPI:1356672463
Name:TRAVISONO, CHRISTINA MARIA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:MARIA
Last Name:TRAVISONO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:CHRISTINA
Other - Middle Name:MARIA
Other - Last Name:DELEO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 16149
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-0697
Mailing Address - Country:US
Mailing Address - Phone:401-793-3922
Mailing Address - Fax:401-435-7069
Practice Address - Street 1:164 SUMMIT AVE
Practice Address - Street 2:ROOM C70
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2853
Practice Address - Country:US
Practice Address - Phone:401-793-3922
Practice Address - Fax:401-435-7069
Is Sole Proprietor?:No
Enumeration Date:2010-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00540363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0014665OtherMEDICARE PTAN
RICD78903Medicaid