Healthcare Provider Details

I. General information

NPI: 1619778305
Provider Name (Legal Business Name): NICOLE ROBERTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4324 N 132ND ST
OMAHA NE
68164-5407
US

IV. Provider business mailing address

4715 S 132ND ST
OMAHA NE
68137-1899
US

V. Phone/Fax

Practice location:
  • Phone: 531-999-6262
  • Fax:
Mailing address:
  • Phone: 402-444-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: