Provider Demographics
NPI:1730764887
Name:GLATT, NIKIMA M (PMHNP-BC, APRN-RX)
Entity type:Individual
Prefix:MRS
First Name:NIKIMA
Middle Name:M
Last Name:GLATT
Suffix:
Gender:F
Credentials:PMHNP-BC, APRN-RX
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 E ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1834
Mailing Address - Country:US
Mailing Address - Phone:315-464-8668
Mailing Address - Fax:
Practice Address - Street 1:850 W HIND DR STE 210
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96821-1845
Practice Address - Country:US
Practice Address - Phone:808-941-9648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY645607363LP0808X
NY403550363LP0808X
HIAPRN-3453-0363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY645607Medicaid