Healthcare Provider Details

I. General information

NPI: 1508364795
Provider Name (Legal Business Name): LAURA ELISABETH GORANITIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 BROADWAY AVE
YOUNGSTOWN OH
44504-1752
US

IV. Provider business mailing address

535 MARMION AVE
YOUNGSTOWN OH
44502-2323
US

V. Phone/Fax

Practice location:
  • Phone: 330-743-9275
  • Fax:
Mailing address:
  • Phone: 330-782-5664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN227225
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: