Provider Demographics
NPI:1134247174
Name:KHITERER, JENNY (NP)
Entity type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:
Last Name:KHITERER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 LILLE LN
Mailing Address - Street 2:APT. 318
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-2699
Mailing Address - Country:US
Mailing Address - Phone:949-378-3638
Mailing Address - Fax:
Practice Address - Street 1:24012 CALLE DE LA PLATA
Practice Address - Street 2:SUITE 150 & 230
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3621
Practice Address - Country:US
Practice Address - Phone:949-837-1578
Practice Address - Fax:949-837-8154
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16931363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily