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General NPI Number Information
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NPI Number | 1235727975
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Entity Type | Individual
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Provider Name | NICHOLE RUTH CORTEZ RDN
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Gender | Female
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Dates
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Enumeration Date | 01/07/2021
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Last Update Date | 08/24/2025
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Provider Practice Location Address
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Address Line | 13622 BASCOM ST
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City | CALDWELL
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State | ID
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Zip | 83607-9034
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Country | US
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Telephone | 208-266-9970
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 MONTEREY WAY APT A3
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City | LAWRENCE
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State | KS
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Zip | 66049-4621
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Country | US
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Telephone | 224-717-4388
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | D-1214
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133VN1004X
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Taxonomy Name | Pediatric Nutrition Registered Dietitian
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License Number |
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License Number State |
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