MEDICARE: MS. GLORIA ALICE JOHNSTON NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R219675	MD

General Provider Information

NPI Number	:	1013601608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GLORIA ALICE JOHNSTON NP

Provider Business Mailing Address
First Line	:	50 POST OFFICE RD STE 302
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20602-3704
Country	:	US
Telephone Number	:	240-353-2516
Fax Number	:	240-488-8893

Provider Business Practice Location Address
First Line	:	50 POST OFFICE RD STE 302
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20602-3704
Country	:	US
Telephone Number	:	240-353-2516
Fax Number	:	240-448-8893

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2023
Last Update Date	:	09/15/2025

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