Basic Information
| Provider Information | |||||||||
| NPI: | 1780650358 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | URSINO | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | AGATINO | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1625 MOTTMAN RD SW | ||||||||
| Address2: | SUITE A | ||||||||
| City: | TUMWATER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985127833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605282830 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9040 REID ST | ||||||||
| Address2: | MADIGAN ARMY MEDICAL CENTER ATTN MCHJ QCR | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984311100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539682252 | ||||||||
| FaxNumber: | 2539683278 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2006 | ||||||||
| LastUpdateDate: | 09/14/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA10004807 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.