Provider Demographics
NPI:1558243261
Name:ROBERTS, TAYANA LYNN
Entity type:Individual
Prefix:
First Name:TAYANA
Middle Name:LYNN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAYANA
Other - Middle Name:LYNN
Other - Last Name:BRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5411 S 122ND ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-3420
Mailing Address - Country:US
Mailing Address - Phone:531-310-4524
Mailing Address - Fax:
Practice Address - Street 1:5411 S 122ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-3420
Practice Address - Country:US
Practice Address - Phone:531-310-4524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion