MEDICARE: RACHAEL L GROTHEN DIETICIAN

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	133V00000X	Registered Dietitian	DI00001071	WA
2	133NN1002X	Nutrition Education Nutritionist	DI00001071	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508068222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHAEL L GROTHEN DIETICIAN

Provider Business Mailing Address
First Line	:	3600 LIND AVE SW
Second Line	:	SUITE 100 ATTN CREDENTIALING
City	:	RENTON
State	:	WA
Zip	:	98057-4970
Country	:	US
Telephone Number	:	425-690-2715
Fax Number	:

Provider Business Practice Location Address
First Line	:	3600 LIND AVE SW STE 160
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98057-4934
Country	:	US
Telephone Number	:	425-690-3513
Fax Number	:	425-690-9513

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	08/04/2020

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