Provider Demographics
NPI:1235412545
Name:CRISCUOLO, DIANE MELISSA (NP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MELISSA
Last Name:CRISCUOLO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:HOECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 WELCH RD STE 301
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1521
Mailing Address - Country:US
Mailing Address - Phone:650-724-5338
Mailing Address - Fax:
Practice Address - Street 1:321 MIDDLEFIELD RD STE 225
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4010
Practice Address - Country:US
Practice Address - Phone:650-724-5338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22216363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner