Provider Demographics
NPI:1972315711
Name:PRUSHA, DANI AG
Entity type:Individual
Prefix:
First Name:DANI
Middle Name:AG
Last Name:PRUSHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 GREYSON DR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68133-2487
Mailing Address - Country:US
Mailing Address - Phone:402-315-8722
Mailing Address - Fax:
Practice Address - Street 1:2006 GREYSON DR
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68133-2487
Practice Address - Country:US
Practice Address - Phone:402-315-8722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant