Provider Demographics
NPI:1740365287
Name:JOHNSON, CHARMENE LINNETTE (APRN)
Entity type:Individual
Prefix:MRS
First Name:CHARMENE
Middle Name:LINNETTE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7908 HEARTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-4321
Mailing Address - Country:US
Mailing Address - Phone:301-520-7420
Mailing Address - Fax:
Practice Address - Street 1:400 6TH ST SW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-2753
Practice Address - Country:US
Practice Address - Phone:202-727-8096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR133001363LF0000X
DCRN66572363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD136767ZAWGMedicare UPIN