Individual ProviderStefani JohnstonNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address2512 E Dupont Rd, Suite 200, Fort Wayne, IN 46825-1675(260) 432-4400PECOS EnrollmentBased on the most recent information from CMS, provider Stefani Johnston is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1831189554Provider TypeIndividualFull NameJohnston, StefaniCredentialNPGenderFemaleSole ProprietorNoEnumeration Date10/25/2005Last Updated7/23/2010Contact InformationPractice LocationPractice Address2512 E Dupont Rd, Suite 200, Fort Wayne, IN 46825-1675Phone(260) 432-4400Fax(260) 969-6898Mailing LocationMailing Address2512 E Dupont Rd, Suite 200, Fort Wayne, IN 46825-1675Phone(260) 432-4400Fax(260) 969-6898Provider TaxonomiesCodeDescriptionLicenseCode363L00000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense71000852AIndianaCode163W00000XDescriptionRegistered NurseNursing Service ProvidersLicense28113743AIndianaProvider IdentifiersIDDescriptionIssuerID200338290DescriptionMedicaidIssuerUnlistedIndiana