Healthcare Provider Details

I. General information

NPI: 1780361832
Provider Name (Legal Business Name): EMANUELA KAROLINA GORRITA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMANUELA KAROLINA WIKTOR

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5941 JOHNSON RD
HAMPTONVILLE NC
27020-7803
US

IV. Provider business mailing address

5941 JOHNSON RD
HAMPTONVILLE NC
27020-7803
US

V. Phone/Fax

Practice location:
  • Phone: 773-550-6167
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9523086
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: