Healthcare Provider Details

I. General information

NPI: 1437112885
Provider Name (Legal Business Name): JOHN MICHAEL SHOLAR PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 OAK ST SE
SALEM OR
97301-4019
US

IV. Provider business mailing address

1118 OAK ST SE
SALEM OR
97301-4019
US

V. Phone/Fax

Practice location:
  • Phone: 503-585-4949
  • Fax: 503-585-4965
Mailing address:
  • Phone: 504-585-4949
  • Fax: 503-585-4965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number200450071NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: