Provider Demographics
NPI:1396561429
Name:BODE, CORTNEY (RDN, LD)
Entity type:Individual
Prefix:
First Name:CORTNEY
Middle Name:
Last Name:BODE
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:CORTNEY
Other - Middle Name:
Other - Last Name:O'REAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN, LD
Mailing Address - Street 1:700 PRESLEY RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-0566
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44 PORTLAND ST FL 4
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-2023
Practice Address - Country:US
Practice Address - Phone:617-249-3253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered