Organization
TRANSFORM DIET AND WELLNESS CENTER, LLC
Active
Parent organization
WISCONSIN VEIN CENTER AND MEDISPA, SC
Organization subpart
Yes
Provider details
NPI number
Legal business name
WISCONSIN VEIN CENTER AND MEDISPA, SC
Authorized official
MISS AMELIA TOLLEFSON APNP (NURSE PRACTIONER)
(262) 746-9088
Entity
Organization
Contact information
Practice address
1231 GEORGE TOWNE DR STE B, PEWAUKEE, WI 53072-2757
(262) 746-9088
(262) 746-9087
Mailing address
1231 GEORGE TOWNE DR STE B, PEWAUKEE, WI 53072-2757
(262) 746-9088
(262) 746-9087
Taxonomy
Speciality
Code
Description
License number
State
132700000X
Dietary Manager
Primary
—
—
Other
Enumeration date
10/02/2012
Last updated
10/02/2012
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