Nichole Stachewicz Johnson, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DSO37468 Issued in PA

Practice address

4206 E Lake Rd
Erie, PA 16511-1357

Phone

(814) 899-0602

Fax

(814) 898-0990

NPI assigned

Jul 10, 2008

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

Medicare fee-for-service enrollment

Enrolled in PA

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

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

{
    "created_epoch": "1215648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215648000000",
    "number": "1457515355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4206 E LAKE RD",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165111357",
            "telephone_number": "814-899-0602",
            "fax_number": "814-898-0990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4206 E LAKE RD",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165111357",
            "telephone_number": "814-899-0602",
            "fax_number": "814-898-0990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "NICHOLE",
        "middle_name": "STACHEWICZ",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-10",
        "last_updated": "2008-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DSO37468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Ann Johnson, LPC
• Kurt A Johnson, DMD
• Linda M Johnson, CRNP
• Mark Johnson
• Matthew Johnson, M.D.
• Rashada Johnson
• Selena L. Johnson
• Taylor Hildebrandt Johnson, DDS
• Thomas M Johnson, PA-C
• Johnson'S Home Health Care LLC

• General Practice Dentistry in Erie, PA
• Providers in Erie, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2008; 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.