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General NPI Number Information
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NPI Number | 1205831369
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Entity Type | Individual
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Provider Name | DIANE MARIE CARUSO FNP
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Gender | Female
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 02/07/2012
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Provider Practice Location Address
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Address Line | 11709 STATESVILLE BLVD
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City | CLEVELAND
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State | NC
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Zip | 27013-9418
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Country | US
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Telephone | 704-278-0300
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Fax | 704-278-0636
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Provider Business Mailing Address
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Address Line | 11709 STATESVILLE BLVD
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City | CLEVELAND
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State | NC
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Zip | 27013-9418
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Country | US
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Telephone | 704-278-0300
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Fax | 704-278-0636
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 200670
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License Number State | NC
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