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Organization
MODERN MEDICAL NUTRITION THERAPY, LLC
Active
Organization
MODERN MEDICAL NUTRITION THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAPHAEL OVONLEN MPH, MS, RDN, LMNT, (CEO)
(402) 618-0209
Entity
Organization
Contact information
Practice address
530 S 13TH ST, STE 100, LINCOLN, NE 68508-2710
(402) 618-0209
(402) 905-0321
Mailing address
6554 S 117TH ST, OMAHA, NE 68137-5726
(402) 618-0209
(402) 905-0321
Taxonomy
Speciality
Code
Description
License number
State
133VN1006X
Metabolic Nutrition Registered Dietitian
Primary
752
NE
Other
Enumeration date
11/05/2016
Last updated
11/05/2016
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