MODERN MEDICAL NUTRITION THERAPY, LLC (NPI# 1699217885) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699217885 |
| Entity Type | Organization |
| Organization Name | MODERN MEDICAL NUTRITION THERAPY, LLC |
| Practice Address |
530 S 13th St Ste 100 Lincoln NE 68508-2710 |
| Mailing Address |
6554 S 117th St Omaha NE 68137-5726 |
| Practice Telephone | 4026180209 |
| Practice Fax Number | 4029050321 |
| Mailing Telephone | 4026180209 |
| Mailing Fax Number | 4029050321 |
| Enumeration Date | 2016-11-05 |
| Last Update Date | 2016-11-05 |
| Authorized Official Name | MR. RAPHAEL OVONLEN (CEO) |
| Authorized Official Telephone | 4026180209 |
| Authorized Official Credential | MPH, MS, RDN, LM |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 133VN1006X |
Dietitian, Registered Specialization: Nutrition, Metabolic |
752 | NE | Dietary & Nutritional Service Providers |
| Street Address |
530 S 13TH ST STE 100 |
| City | LINCOLN |
| State | NE |
| Zip Code | 68508-2710 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952941148 | Jacob Johnson | Counselor | 815 K Street, Lincoln, NE 68508 | 2020-01-15 |
| 1518364348 | Jairrion Raino | Social Worker | 1000 South 13th Street, Lincoln, NE 68508 | 2014-11-21 |
| 1518204536 | Robert Scott Fox | Clinic/Center | 110 Q St., Lincoln, NE 68508 | 2013-01-10 |
| 1033418355 | Kimberly Marie Widicker-densberger | Social Worker | 1005 O Street, Suite 300, Lincoln, NE 68508 | 2011-03-25 |
| 1578797064 | Amber N Waddell | Substance Abuse Rehabilitation Facility | 721 J St, Lincoln, NE 68508 | 2009-05-12 |
| 1396803490 | Bright Smile Dental | Dentist | 140 So 16th Street, Lincoln, NE 68508 | 2006-12-04 |
| 1265086698 | Mindful Counseling and Wellness, LLC | Clinic/Center | 421 S 9th St Ste 126, Lincoln, NE 68508 | 2019-07-24 |
| 1366933624 | Leslie Delong, Phd, P.C. | Psychologist | 650 J St Ste 201, Lincoln, NE 68508 | 2018-05-22 |
| 1285153734 | Sara Qadi | Dentist | 4000 E Campus Loop, Lincoln, NE 68508 | 2017-09-15 |
| 1477070415 | Denise J Barrow | Counselor | 815 K St, Lincoln, NE 68508 | 2017-08-29 |
| Find all providers in zip 68508 | ||||
| Taxonomy Code | 133VN1006X |
| Grouping | Dietary & Nutritional Service Providers |
| Classification | Dietitian, Registered |
| Specialization | Nutrition, Metabolic |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316489065 | Raphael Ovonlen | Dietitian, Registered | 6554 S 117th St, Omaha, NE 68137-5726 | 2016-11-12 |
| 1073769014 | Shelly Lynn Asplin | Dietitian, Registered | 1000 S 178th St, Omaha, NE 68118-3542 | 2008-08-11 |
| 1356430391 | Cheryl Lavonne Berman | Dietitian, Registered | 4101 Woolworth Ave, Omaha, NE 68105-1850 | 2006-10-11 |
Please comment or provide details below to improve the information on MODERN MEDICAL NUTRITION THERAPY, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.