Provider Demographics
NPI:1457129900
Name:JOHNSON, SHOLARA CATHERINE (RN)
Entity Type:Individual
Prefix:
First Name:SHOLARA
Middle Name:CATHERINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SHOLARA
Other - Middle Name:CATHERINE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN,BSN,CDCES,CCM
Mailing Address - Street 1:3703 CASTLE TER
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-4769
Mailing Address - Country:US
Mailing Address - Phone:301-996-8361
Mailing Address - Fax:
Practice Address - Street 1:3703 CASTLE TER
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-4769
Practice Address - Country:US
Practice Address - Phone:301-996-8361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1028193163W00000X
MDR144873163WC0400X, 163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management