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 1:1500 SW 10TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1301
Practice Address - Country:US
Practice Address - Phone:785-354-6440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2309133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered