Provider Demographics
NPI:1154658516
Name:CORTEZ, NINA MARIE (CBT)
Entity Type:Individual
Prefix:MRS
First Name:NINA
Middle Name:MARIE
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:CBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7425 RIVER SHORE LN
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-2140
Mailing Address - Country:US
Mailing Address - Phone:612-644-6353
Mailing Address - Fax:
Practice Address - Street 1:221 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:OSSEO
Practice Address - State:MN
Practice Address - Zip Code:55369-1201
Practice Address - Country:US
Practice Address - Phone:612-644-6353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist