Provider Demographics
NPI:1841206356
Name:GOFF, LINDA M (RN, BSN, FNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:GOFF
Suffix:
Gender:F
Credentials:RN, BSN, FNP
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:M
Other - Last Name:SELINSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN, FNP
Mailing Address - Street 1:4103 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-6600
Mailing Address - Country:US
Mailing Address - Phone:315-637-7800
Mailing Address - Fax:315-637-7808
Practice Address - Street 1:4103 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-6600
Practice Address - Country:US
Practice Address - Phone:315-637-7800
Practice Address - Fax:315-637-7808
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334977363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02823976Medicaid
NY02823976Medicaid