Provider Demographics
NPI:1972985612
Name:GOLIBER, NIKITA (FNP)
Entity type:Individual
Prefix:
First Name:NIKITA
Middle Name:
Last Name:GOLIBER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:NIKITA
Other - Middle Name:
Other - Last Name:HUNGERFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 MONTGOMERY HTS
Mailing Address - Street 2:
Mailing Address - City:WADDINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:13694-7712
Mailing Address - Country:US
Mailing Address - Phone:153-887-8723
Mailing Address - Fax:315-713-6511
Practice Address - Street 1:4 MONTGOMERY HTS
Practice Address - Street 2:
Practice Address - City:WADDINGTON
Practice Address - State:NY
Practice Address - Zip Code:13694-7712
Practice Address - Country:US
Practice Address - Phone:153-887-8723
Practice Address - Fax:315-713-6511
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339790207RH0003X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04179508Medicaid