Provider Demographics
NPI:1104198316
Name:BONO, LISA SHAY (CRNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:SHAY
Last Name:BONO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:FULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 NOLTE DR
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-7111
Mailing Address - Country:US
Mailing Address - Phone:833-246-7662
Mailing Address - Fax:724-671-1706
Practice Address - Street 1:1 NOLTE DR
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-7111
Practice Address - Country:US
Practice Address - Phone:833-246-7662
Practice Address - Fax:724-671-1706
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011517363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily