Healthcare Provider Details

I. General information

NPI: 1689482978
Provider Name (Legal Business Name): RAINA ROEBUCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 S 120TH ST
OMAHA NE
68144-1630
US

IV. Provider business mailing address

1616 S 120TH ST
OMAHA NE
68144-1630
US

V. Phone/Fax

Practice location:
  • Phone: 531-299-2280
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: