Provider Demographics
NPI:1740154442
Name:BERNACCHI, GABRIEL ANTHONY JR
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:ANTHONY
Last Name:BERNACCHI
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16110 29TH ST NW
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:MT
Mailing Address - Zip Code:59221-9315
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16110 29TH ST NW
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:MT
Practice Address - Zip Code:59221-9315
Practice Address - Country:US
Practice Address - Phone:406-489-0694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker