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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