Provider Demographics
NPI:1780361832
Name:GORRITA, EMANUELA KAROLINA
Entity type:Individual
Prefix:
First Name:EMANUELA
Middle Name:KAROLINA
Last Name:GORRITA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMANUELA
Other - Middle Name:KAROLINA
Other - Last Name:WIKTOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5941 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27020-7803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5941 JOHNSON RD
Practice Address - Street 2:
Practice Address - City:HAMPTONVILLE
Practice Address - State:NC
Practice Address - Zip Code:27020-7803
Practice Address - Country:US
Practice Address - Phone:773-550-6167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9523086163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse