Provider Demographics
NPI:1477502870
Name:FRAGIONE, GINA M (PA)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:M
Last Name:FRAGIONE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13709 210TH ST E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-6625
Mailing Address - Country:US
Mailing Address - Phone:360-229-4438
Mailing Address - Fax:855-696-7932
Practice Address - Street 1:13709 210TH ST E
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-6625
Practice Address - Country:US
Practice Address - Phone:360-229-4438
Practice Address - Fax:855-696-7932
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004361363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8419392Medicaid
P87486Medicare UPIN
WAAB36857Medicare ID - Type Unspecified