MEDICARE: REGENTS DIETITIAN SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133VN1201X	Obesity and Weight Management Nutrition Registered Dietitian
2	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1225907876
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGENTS DIETITIAN SERVICES

Provider Business Mailing Address
First Line	:	1621 SEATTLE HILL RD APT F1
Second Line	:
City	:	BOTHELL
State	:	WA
Zip	:	98012-4103
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1621 SEATTLE HILL RD APT F1
Second Line	:
City	:	BOTHELL
State	:	WA
Zip	:	98012-4103
Country	:	US
Telephone Number	:	612-559-7227
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER/CEO
Name	:	DR. NICOLE NYASHA KARONGO
Credential	:	PHD, MPH, RDN, LDN
Telephone Number	:	612-559-7227

Provider Enumeration Date	:	11/03/2025
Last Update Date	:	11/03/2025

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