NPIMap

Organization Active NPI

Transform Diet and Wellness Center, LLC

  • Dietary Manager
  • Pewaukee, WI
National Provider Identifier
1811249758
Registry record updated Oct 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dietary ManagerTaxonomy code 132700000X
Legal business name
TRANSFORM DIET AND WELLNESS CENTER, LLC
Practice address
1231 George Towne Dr Ste B
Pewaukee, WI 53072-2757
Phone
(262) 746-9088
Fax
(262) 746-9087
NPI assigned
Oct 2, 2012
Organization subpart
Yes
Parent organization
WISCONSIN VEIN CENTER AND MEDISPA, SCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 2, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Miss Amelia Tollefson, APNP
Title
Nurse Practioner
Phone
(262) 746-9088

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dietary ManagerGroup: 193400000X SINGLE SPECIALTY GROUP 132700000X Primary

Addresses

Primary practice location

1231 George Towne Dr Ste B
Pewaukee, WI 53072-2757

Mailing address

1231 George Towne Dr Ste B
Pewaukee, WI 53072-2757
Phone (262) 746-9088

National Provider Directory

National Provider Directory
Part of
Wisconsin Vein Center and Medispa SC

Locations

1231 George Towne Dr
Ste B
Pewaukee, WI 53072
Phone (262) 746-9088

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1349136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349136000000",
    "number": "1811249758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1231 GEORGE TOWNE DR STE B",
            "city": "PEWAUKEE",
            "state": "WI",
            "postal_code": "530722757",
            "telephone_number": "262-746-9088",
            "fax_number": "262-746-9087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1231 GEORGE TOWNE DR STE B",
            "city": "PEWAUKEE",
            "state": "WI",
            "postal_code": "530722757",
            "telephone_number": "262-746-9088",
            "fax_number": "262-746-9087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRANSFORM DIET AND WELLNESS CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WISCONSIN VEIN CENTER AND MEDISPA, SC",
        "enumeration_date": "2012-10-02",
        "last_updated": "2012-10-02",
        "status": "A",
        "authorized_official_last_name": "TOLLEFSON",
        "authorized_official_first_name": "AMELIA",
        "authorized_official_title_or_position": "NURSE PRACTIONER",
        "authorized_official_telephone_number": "262-746-9088",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "APNP"
    },
    "taxonomies": [
        {
            "code": "132700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietary Manager",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pewaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.