Provider Demographics
NPI:1205831369
Name:CARUSO, DIANE MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:CARUSO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11709 STATESVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:NC
Mailing Address - Zip Code:27013-9418
Mailing Address - Country:US
Mailing Address - Phone:704-278-0300
Mailing Address - Fax:704-278-0636
Practice Address - Street 1:11709 STATESVILLE BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:NC
Practice Address - Zip Code:27013-9418
Practice Address - Country:US
Practice Address - Phone:704-278-0300
Practice Address - Fax:704-278-0636
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200670363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCZF0000156Medicaid