Individual
MARCO NMN CRISCIONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
512 N FRANKLIN ST, JENKS, OK 74037-2489
(918) 582-6200
Mailing address
512 N FRANKLIN ST, JENKS, OK 74037-2489
(918) 582-6200
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0103010O
OK
363LA2100X
Acute Care Nurse Practitioner
0103010
OK
363LF0000X
Family Nurse Practitioner
0103010
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0103010
LICENSE
OK
05
—
200741260A
—
OK
01
—
2M8551
MEDICARE
OK
Enumeration date
08/14/2017
Last updated
02/08/2023
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