Provider Demographics
NPI:1134645922
Name:CRISCIONE, MARCO NMN (NP)
Entity Type:Individual
Prefix:
First Name:MARCO
Middle Name:NMN
Last Name:CRISCIONE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:MARCO
Other - Middle Name:
Other - Last Name:CRISCIONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNP
Mailing Address - Street 1:512 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-2489
Mailing Address - Country:US
Mailing Address - Phone:918-582-6200
Mailing Address - Fax:
Practice Address - Street 1:512 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-2489
Practice Address - Country:US
Practice Address - Phone:918-582-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0103010363LA2100X, 363LF0000X
OK0103010O363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0103010OtherLICENSE
OK2M8551OtherMEDICARE
OK200741260AMedicaid