Provider Demographics
NPI:1730914946
Name:POSITIVE NUTRITION OF OMAHA LLC
Entity type:Organization
Organization Name:POSITIVE NUTRITION OF OMAHA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WEGENER
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CSSD, LMNT
Authorized Official - Phone:402-669-2705
Mailing Address - Street 1:11414 W CENTER RD STE 321
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4420
Mailing Address - Country:US
Mailing Address - Phone:402-669-2705
Mailing Address - Fax:
Practice Address - Street 1:11414 W CENTER RD STE 321
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4420
Practice Address - Country:US
Practice Address - Phone:402-669-2705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty