Healthcare Provider Details

I. General information

NPI: 1053215863
Provider Name (Legal Business Name): AYJZANA LARAY ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8742 READ ST
OMAHA NE
68122-5431
US

IV. Provider business mailing address

4805 N 72ND ST
OMAHA NE
68134-2304
US

V. Phone/Fax

Practice location:
  • Phone: 153-136-1386
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: