Transform Diet and Wellness Center, LLC

NPI #1811249758 in Pewaukee, Wisconsin

Provider Information

NPI Number: 1811249758
Entity Type: Organization
Organization Name: Transform Diet and Wellness Center, LLC
Subpart: Yes (part of a larger organization)
Parent Organization: WISCONSIN VEIN CENTER AND MEDISPA, SC
Primary Specialty: Dietary Manager
Enumeration Date: Oct 2, 2012
Last Updated: Oct 2, 2012

Practice Location

Address: 1231 GEORGE TOWNE DR STE B
City: Pewaukee
State: Wisconsin
ZIP Code: 53072-2757
Phone: (262) 746-9088

Authorized Official

Name: MISS AMELIA TOLLEFSON, APNP
Title: NURSE PRACTIONER
Phone: (262) 746-9088

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dietary Manager	132700000X	Primary

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