Provider Demographics
NPI:1275333262
Name:PRASEUTH GOSS, DIANE JONELLE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:JONELLE
Last Name:PRASEUTH GOSS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 PONTIAC DR
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-7884
Mailing Address - Country:US
Mailing Address - Phone:402-518-0188
Mailing Address - Fax:
Practice Address - Street 1:6305 AMES AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-2027
Practice Address - Country:US
Practice Address - Phone:888-226-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide