MEDICARE: MRS. NICOLE ELIZABETH GARDINER RDN

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	61365012	WA

General Provider Information

NPI Number	:	1962129551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE ELIZABETH GARDINER RDN

Provider Business Mailing Address
First Line	:	12345 LAKE CITY WAY NE # 3270
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-5401
Country	:	US
Telephone Number	:	562-336-6942
Fax Number	:

Provider Business Practice Location Address
First Line	:	12345 LAKE CITY WAY NE # 3270
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98125-5401
Country	:	US
Telephone Number	:	562-336-6942
Fax Number	:

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

Provider Enumeration Date	:	10/24/2022
Last Update Date	:	12/12/2025

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