Provider Demographics
NPI:1285005199
Name:VON HELMS, ANDREA MARIA DIETZ (MS, RD, CD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIA DIETZ
Last Name:VON HELMS
Suffix:
Gender:F
Credentials:MS, RD, CD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:MARIA
Other - Last Name:DIETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CD
Mailing Address - Street 1:13570 W RADISSON DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-7536
Mailing Address - Country:US
Mailing Address - Phone:708-284-0501
Mailing Address - Fax:
Practice Address - Street 1:725 AMERICAN AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5031
Practice Address - Country:US
Practice Address - Phone:262-928-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2928 - 29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered