Healthcare Provider Details

I. General information

NPI: 1700290848
Provider Name (Legal Business Name): LANISA MARTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LANISA TAFOYA

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11446 VALLEY RIDGE DR
PAPILLION NE
68046-6271
US

IV. Provider business mailing address

11446 VALLEY RIDGE DR
PAPILLION NE
68046-6271
US

V. Phone/Fax

Practice location:
  • Phone: 402-916-4539
  • Fax: 402-403-5857
Mailing address:
  • Phone: 402-916-4539
  • Fax: 402-403-5857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: