Provider Demographics
NPI:1588628523
Name:BONELLO, LORI (CRNA)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:BONELLO
Suffix:
Gender:
Credentials:CRNA
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:WALTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:
Practice Address - Street 1:25 MONUMENT RD STE 270
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5073
Practice Address - Country:US
Practice Address - Phone:717-741-8250
Practice Address - Fax:717-741-8289
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR132865367500000X
PARN288168L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102266838Medicaid
MD871200000Medicaid
MD871200000Medicaid
PA102266838Medicaid