Provider Demographics
NPI:1235727975
Name:CORTEZ, NICHOLE RUTH (RDN)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:RUTH
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:RUTH
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 MONTEREY WAY APT A3
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-4621
Mailing Address - Country:US
Mailing Address - Phone:224-717-4388
Mailing Address - Fax:
Practice Address - Street 1:13622 BASCOM ST
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83607-9034
Practice Address - Country:US
Practice Address - Phone:208-266-9970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2025-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
D-1214133V00000X
133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered