Healthcare Provider Details

I. General information

NPI: 1003123464
Provider Name (Legal Business Name): LORRAINE KAY BONALDI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 PYRAMID WAY STE 208
SPARKS NV
89431-4470
US

IV. Provider business mailing address

2880 ALPINE CREEK RD
RENO NV
89519-7355
US

V. Phone/Fax

Practice location:
  • Phone: 775-287-8102
  • Fax:
Mailing address:
  • Phone: 775-287-8102
  • Fax: 775-398-1984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN001236
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN18190
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN001236
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: