Healthcare Provider Details

I. General information

NPI: 1093667073
Provider Name (Legal Business Name): ONOBEREVUNE PATIENCE AJAYI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5736 N 130TH ST
OMAHA NE
68164-1353
US

IV. Provider business mailing address

5736 N 130TH ST
OMAHA NE
68164-1353
US

V. Phone/Fax

Practice location:
  • Phone: 402-321-7608
  • Fax:
Mailing address:
  • Phone: 402-321-7608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: