Individual
MRS. CHRISTINA MARIA TRAVISONO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
164 SUMMIT AVE, ROOM C70, PROVIDENCE, RI 02906-2853
(401) 793-3922
(401) 435-7069
Mailing address
PO BOX 16149, RUMFORD, RI 02916-0697
(401) 793-3922
(401) 435-7069
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00540
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0014665
MEDICARE PTAN
RI
05
—
CD78903
—
RI
Enumeration date
01/29/2010
Last updated
01/29/2020
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