Active NPI
Elyse M Vanbogaert, RD
- Registered Dietitian
- Greenfield, WI
National Provider Identifier
1457836942
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 317629
- Practice address
- 3400 South 103Rd St
Suite 300
Greenfield, WI 53277 - Phone
- (262) 366-3655
- NPI assigned
- Oct 1, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 317629 | WI | Primary |
Addresses
Primary practice location
3400 South 103Rd St
Suite 300
Greenfield, WI 53277
Mailing address
3340 N Newhall St
Milwaukee, WI 53211-3044
Phone (630) 306-3133
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 317629 | WI | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1538352000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1538352000000",
"number": "1457836942",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3340 N NEWHALL ST",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532113044",
"telephone_number": "630-306-3133"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3400 SOUTH 103RD ST",
"address_2": "SUITE 300",
"city": "GREENFIELD",
"state": "WI",
"postal_code": "53277",
"telephone_number": "262-366-3655"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANBOGAERT",
"first_name": "ELYSE",
"middle_name": "M",
"credential": "RD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-10-01",
"last_updated": "2018-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "WI",
"license": "317629",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greenfield, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.