NPIMap

Organization Active NPI

Modern Medical Nutrition Therapy, LLC

  • Metabolic Nutrition Registered Dietitian
  • Lincoln, NE
National Provider Identifier
1699217885
Registry record updated Nov 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Metabolic Nutrition Registered DietitianTaxonomy code 133VN1006X
License
752 Issued in NE
Legal business name
MODERN MEDICAL NUTRITION THERAPY, LLC
Practice address
530 S 13TH St
Ste 100
Lincoln, NE 68508-2710
Phone
(402) 618-0209
Fax
(402) 905-0321
NPI assigned
Nov 5, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Raphael Ovonlen, MPH, MS, RDN, LMNT,
Title
Ceo
Phone
(402) 618-0209

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Metabolic Nutrition Registered DietitianGroup: 193400000X SINGLE SPECIALTY GROUP 133VN1006X 752 NE Primary

Addresses

Primary practice location

530 S 13TH St
Ste 100
Lincoln, NE 68508-2710

Mailing address

6554 S 117TH St
Omaha, NE 68137-5726
Phone (402) 618-0209

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1478304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478304000000",
    "number": "1699217885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6554 S 117TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681375726",
            "telephone_number": "402-618-0209",
            "fax_number": "402-905-0321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 S 13TH ST",
            "address_2": "STE 100",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685082710",
            "telephone_number": "402-618-0209",
            "fax_number": "402-905-0321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN MEDICAL NUTRITION THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-05",
        "last_updated": "2016-11-05",
        "status": "A",
        "authorized_official_last_name": "OVONLEN",
        "authorized_official_first_name": "RAPHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "402-618-0209",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MPH, MS, RDN, LMNT,"
    },
    "taxonomies": [
        {
            "code": "133VN1006X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered, Nutrition, Metabolic",
            "state": "NE",
            "license": "752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lincoln, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.