Provider Demographics
NPI:1194356006
Name:CORTEZ, NICOLETTE ALYSE (DNP)
Entity type:Individual
Prefix:DR
First Name:NICOLETTE
Middle Name:ALYSE
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 E BARNETT RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8284
Mailing Address - Country:US
Mailing Address - Phone:541-450-9792
Mailing Address - Fax:
Practice Address - Street 1:1609 E BARNETT RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8284
Practice Address - Country:US
Practice Address - Phone:541-450-9792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2024-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0995301363L00000X
OR202213227363LA2100X
OR202213227NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care