Provider Demographics
NPI:1710206206
Name:STATEN, URSULA CHRISTINA (LMT)
Entity Type:Individual
Prefix:MS
First Name:URSULA
Middle Name:CHRISTINA
Last Name:STATEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7053
Mailing Address - Street 2:
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-7001
Mailing Address - Country:US
Mailing Address - Phone:228-383-0248
Mailing Address - Fax:
Practice Address - Street 1:1057 DIVISION ST
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-2934
Practice Address - Country:US
Practice Address - Phone:228-383-0248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-23
Last Update Date:2010-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS319173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist