Provider Demographics
NPI:1780650358
Name:URSINO, CHRISTOPHER AGATINO (PAC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:AGATINO
Last Name:URSINO
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 MOTTMAN RD SW
Mailing Address - Street 2:SUITE A
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-7833
Mailing Address - Country:US
Mailing Address - Phone:360-528-2830
Mailing Address - Fax:
Practice Address - Street 1:9040 REID ST
Practice Address - Street 2:MADIGAN ARMY MEDICAL CENTER ATTN MCHJ QCR
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1100
Practice Address - Country:US
Practice Address - Phone:253-968-2252
Practice Address - Fax:253-968-3278
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004807363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN