Healthcare Provider Details

I. General information

NPI: 1457129900
Provider Name (Legal Business Name): SHOLARA CATHERINE JOHNSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHOLARA CATHERINE JOHNSON RN,BSN,CDCES,CCM

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3703 CASTLE TER
SILVER SPRING MD
20904-4769
US

IV. Provider business mailing address

3703 CASTLE TER
SILVER SPRING MD
20904-4769
US

V. Phone/Fax

Practice location:
  • Phone: 301-996-8361
  • Fax:
Mailing address:
  • Phone: 301-996-8361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1028193
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberR144873
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberR144873
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: