Provider Demographics
NPI:1558029561
Name:KHATTAIE, GITA (GITA KHATTAIE-FNP)
Entity Type:Individual
Prefix:
First Name:GITA
Middle Name:
Last Name:KHATTAIE
Suffix:
Gender:F
Credentials:GITA KHATTAIE-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7011 N HOWARD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2955
Mailing Address - Country:US
Mailing Address - Phone:559-272-8141
Mailing Address - Fax:
Practice Address - Street 1:7011 N HOWARD ST STE 100
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2955
Practice Address - Country:US
Practice Address - Phone:559-272-8141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015916363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty