Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | APN001236 | NV |
N | 363LF0000X | Nurse Practitioner - Family Medicine | APN001236 | NV |
N | 363LF0000X | Nurse Practitioner - Family Medicine | RN18190 | NV |
NPI | 1003123464 |
---|---|
Provider Name | Lorraine Kay Bonaldi-Moore |
First Address | Reno, NV 89502-6542 |
Second Address | Reno, NV 89502-6542 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2010 |
Last Update Date | 26/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003123464 | (02) | NV |