Provider Demographics
NPI:1710715792
Name:JOHNSON, CHARWANA N (RN)
Entity type:Individual
Prefix:
First Name:CHARWANA
Middle Name:N
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 PUBLIC SQ STE 100
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29532-3220
Mailing Address - Country:US
Mailing Address - Phone:843-598-6093
Mailing Address - Fax:
Practice Address - Street 1:2907 BRIDLE CIR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-7026
Practice Address - Country:US
Practice Address - Phone:843-598-6093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207063163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine