MEDICARE: LACY MARIE ROBLES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1952119828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LACY MARIE ROBLES

Provider Business Mailing Address
First Line	:	14301 FNB PKWY STE 100
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-7200
Country	:	US
Telephone Number	:	402-807-7447
Fax Number	:

Provider Business Practice Location Address
First Line	:	703 HAGGE AVE # NA
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68801-7400
Country	:	US
Telephone Number	:	308-380-8747
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/24/2024
Last Update Date	:	12/24/2024

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Directions to “ LACY MARIE ROBLES ” Practice Location

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