Provider Demographics
NPI:1437285582
Name:CAROLE E JOHNSON, RN, CS, LLC
Entity Type:Organization
Organization Name:CAROLE E JOHNSON, RN, CS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CS
Authorized Official - Phone:301-881-4884
Mailing Address - Street 1:15 E DEER PARK DR
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2000
Mailing Address - Country:US
Mailing Address - Phone:301-881-4884
Mailing Address - Fax:301-740-3577
Practice Address - Street 1:15 E DEER PARK DR
Practice Address - Street 2:SUITE 101B
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2000
Practice Address - Country:US
Practice Address - Phone:301-881-4884
Practice Address - Fax:301-740-3577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-25
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR084348364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Single Specialty