Provider Demographics
NPI:1225907876
Name:REGENTS DIETITIAN SERVICES
Entity type:Organization
Organization Name:REGENTS DIETITIAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:NYASHA
Authorized Official - Last Name:KARONGO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MPH, RDN, LDN
Authorized Official - Phone:612-559-7227
Mailing Address - Street 1:1621 SEATTLE HILL RD APT F1
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-4103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1621 SEATTLE HILL RD APT F1
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-4103
Practice Address - Country:US
Practice Address - Phone:612-559-7227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGENTS CARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-11-03
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight ManagementGroup - Multi-Specialty