OrganizationActive
Modern Medical Nutrition Therapy, LLC
NPI 1699217885 · Metabolic Nutrition Registered Dietitian · Lincoln, NE
Provider details
- NPI number
- 1699217885
- Entity type
- Organization
- Primary specialty
- Metabolic Nutrition Registered DietitianDietary & Nutritional Service Providers
- Organization subpart
- No
- Authorized official
- Raphael Ovonlen, Ceo(402) 618-0209
- License
- 752 (NE)
Specialties & taxonomies
Dietary & Nutritional Service Providers
Practice location
530 S 13th St
Ste 100
Lincoln, NE 68508-2710
Phone: (402) 618-0209
Fax: (402) 905-0321
Approximate (ZIP-level) locationGet directions
Mailing address
6554 S 117th St
Omaha, NE 68137-5726
Registry dates
- Enumerated
- 2016-11-05
- Last updated
- 2016-11-05
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.