Healthcare Provider Details

I. General information

NPI: 1871220004
Provider Name (Legal Business Name): HEAVEN SIERRA BERNACCHI PCW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 08/08/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 AVENUE F
ELY NV
89301-3500
US

IV. Provider business mailing address

STATE OF NEVADA RURAL CLINICS 727 FAIRVIEW DR. SUITE A
CARSON CITY NV
89701-5493
US

V. Phone/Fax

Practice location:
  • Phone: 775-289-1671
  • Fax: 775-289-1561
Mailing address:
  • Phone: 775-684-5000
  • Fax: 775-687-1181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: