Individual
LUZ DANELLY GOTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
8401 MARKET ST, YOUNGSTOWN, OH 44512-6725
(330) 729-2929
(330) 729-1841
Mailing address
4135 BOARDMAN CANFIELD RD STE 101, CANFIELD, OH 44406-9803
(330) 286-5330
(330) 286-5396
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN291902
OH
367500000X
Certified Registered Nurse Anesthetist
Primary
80909
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000602907
ANTHEM
OH
01
—
11958330
CAQH
—
05
—
2948654
—
OH
01
—
8244021
MEDICARE PTAN
OH
01
—
P00723133
MEDICARE RAILROAD
OH
Enumeration date
02/13/2009
Last updated
06/06/2019
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