Provider Demographics
NPI:1750264958
Name:STJOHN, CARLISA MARIA
Entity type:Individual
Prefix:
First Name:CARLISA
Middle Name:MARIA
Last Name:STJOHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 URN ST
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-5661
Mailing Address - Country:US
Mailing Address - Phone:240-303-3039
Mailing Address - Fax:
Practice Address - Street 1:4200 URN ST
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-5661
Practice Address - Country:US
Practice Address - Phone:240-303-3039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide