Provider Demographics
NPI:1083488712
Name:BERNARD-WATTS, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BERNARD-WATTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 S MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:YERINGTON
Mailing Address - State:NV
Mailing Address - Zip Code:89447-2474
Mailing Address - Country:US
Mailing Address - Phone:775-344-8410
Mailing Address - Fax:
Practice Address - Street 1:720 S MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:YERINGTON
Practice Address - State:NV
Practice Address - Zip Code:89447-2474
Practice Address - Country:US
Practice Address - Phone:775-344-8410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator