MEDICARE: MRS. SIERRA DAWN HEFFRON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	171400000X	Health & Wellness Coach
2	172V00000X	Community Health Worker
3	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1831734466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SIERRA DAWN HEFFRON

Provider Business Mailing Address
First Line	:	5246 TILDY LN
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83401-6039
Country	:	US
Telephone Number	:	208-680-5264
Fax Number	:

Provider Business Practice Location Address
First Line	:	5246 TILDY LN
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83401-6039
Country	:	US
Telephone Number	:	208-680-5264
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2019
Last Update Date	:	08/22/2024

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