Stacey Darlene Yahnke, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11264 Issued in MN

Practice address

120 W Main St
Caledonia, MN 55921

Phone

(507) 725-5254

Fax

(507) 725-5406

NPI assigned

Sep 30, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Stacey Darlene Johanson Professional name

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Family Dental Center of Caledonia LLC

  • General Practice Dentistry
  • Caledonia, MN
  • NPI 1619051653
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1124111513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "BOX 72",
            "address_2": "120 W MAIN ST",
            "city": "CALEDONIA",
            "state": "MN",
            "postal_code": "55921",
            "telephone_number": "507-725-5254",
            "fax_number": "507-725-5406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 W MAIN ST",
            "city": "CALEDONIA",
            "state": "MN",
            "postal_code": "55921",
            "telephone_number": "507-725-5254",
            "fax_number": "507-725-5406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YAHNKE",
        "first_name": "STACEY",
        "middle_name": "DARLENE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D11264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACEY",
            "last_name": "JOHANSON",
            "middle_name": "DARLENE",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Gloria Evelan Schroeder
• Senior Management Inc. (Caledonia Care & Rehab)
• Scott Alan Siegersma, MS, LPC ,NCC
• Kristen Lee Tadewald, RDH
• Traveling Health LLC
• Mark Suart Zard, DDS

• General Practice Dentistry in Caledonia, MN
• Providers in Caledonia, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.