Provider Demographics
NPI:1184634727
Name:BONNER, LORI ANN (RD LMNT)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:ANN
Last Name:BONNER
Suffix:
Gender:F
Credentials:RD LMNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 WOOLWORTH AVENUE BLDG 9 RM 104
Mailing Address - Street 2:VA NEBRASKA-WESTERN IOWA HEALTH CARE SYSTEM
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105
Mailing Address - Country:US
Mailing Address - Phone:402-995-4565
Mailing Address - Fax:
Practice Address - Street 1:4101 WOOLWORTH AVENUE BLDG 9 RM 104
Practice Address - Street 2:VA NEBRASKA-WESTERN IOWA HEALTH CARE SYSTEM
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105
Practice Address - Country:US
Practice Address - Phone:402-995-4565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE696133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE278770Medicare ID - Type UnspecifiedPROVIDER NUMBER