Healthcare Provider Details

I. General information

NPI: 1235727975
Provider Name (Legal Business Name): NICHOLE RUTH CORTEZ RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICHOLE RUTH PERKINS

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 08/24/2025
Certification Date: 08/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13622 BASCOM ST
CALDWELL ID
83607-9034
US

IV. Provider business mailing address

1000 MONTEREY WAY APT A3
LAWRENCE KS
66049-4621
US

V. Phone/Fax

Practice location:
  • Phone: 208-266-9970
  • Fax:
Mailing address:
  • Phone: 224-717-4388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberD-1214
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: