Provider Demographics
NPI:1003123464
Name:BONALDI, LORRAINE KAY
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:KAY
Last Name:BONALDI
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 1:2880 ALPINE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-7355
Mailing Address - Country:US
Mailing Address - Phone:775-287-8102
Mailing Address - Fax:775-398-1984
Practice Address - Street 1:1001 PYRAMID WAY STE 208
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-4470
Practice Address - Country:US
Practice Address - Phone:775-287-8102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN18190363LF0000X
NVAPN001236363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1003123464Medicare UPIN