Individual
MICHAEL BONELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(215) 707-3326
(215) 707-8028
Mailing address
2450W HUNTING PARK AVE, PHILADELPHIA, PA 19129-1302
(215) 707-3911
(215) 707-3677
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN540369
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080115
CRNA ID
—
Enumeration date
11/05/2008
Last updated
04/27/2018
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