Provider Demographics
NPI:1306448485
Name:CANTRELL, NITA KATHRYN (MS,RDN/LD, CDCES)
Entity type:Individual
Prefix:MS
First Name:NITA
Middle Name:KATHRYN
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:MS,RDN/LD, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4366 MALAGA ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4340
Mailing Address - Country:US
Mailing Address - Phone:919-270-5928
Mailing Address - Fax:
Practice Address - Street 1:4366 MALAGA ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4340
Practice Address - Country:US
Practice Address - Phone:919-270-5928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLD-0874133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered