Provider Demographics
NPI:1962379792
Name:FITVENTURES PEWAUKEE INC
Entity type:Organization
Organization Name:FITVENTURES PEWAUKEE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAYDEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMETSON
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:262-347-1843
Mailing Address - Street 1:1450 CAPITOL DR UNIT C
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-2608
Mailing Address - Country:US
Mailing Address - Phone:262-347-1843
Mailing Address - Fax:855-978-2028
Practice Address - Street 1:1450 CAPITOL DR UNIT C
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-2608
Practice Address - Country:US
Practice Address - Phone:262-347-1843
Practice Address - Fax:855-978-2028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-17
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty