Healthcare Provider Details

I. General information

NPI: 1962129551
Provider Name (Legal Business Name): NICOLE ELIZABETH GARDINER RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE ELIZABETH MORGAN

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12345 LAKE CITY WAY NE # 3270
SEATTLE WA
98125-5401
US

IV. Provider business mailing address

12345 LAKE CITY WAY NE # 3270
SEATTLE WA
98125-5401
US

V. Phone/Fax

Practice location:
  • Phone: 562-336-6942
  • Fax:
Mailing address:
  • Phone: 562-336-6942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number61365012
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: