Provider Demographics
NPI:1871220004
Name:BERNACCHI, HEAVEN SIERRA (PCW)
Entity type:Individual
Prefix:
First Name:HEAVEN
Middle Name:SIERRA
Last Name:BERNACCHI
Suffix:
Gender:F
Credentials:PCW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STATE OF NEVADA RURAL CLINICS
Mailing Address - Street 2:727 FAIRVIEW DR. SUITE A
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-5493
Mailing Address - Country:US
Mailing Address - Phone:775-684-5000
Mailing Address - Fax:775-687-1181
Practice Address - Street 1:1675 AVENUE F
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:NV
Practice Address - Zip Code:89301-3500
Practice Address - Country:US
Practice Address - Phone:775-289-1671
Practice Address - Fax:775-289-1561
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator