Healthcare Provider Details

I. General information

NPI: 1518748995
Provider Name (Legal Business Name): KRISTINA DYKHOUSE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S SPLITROCK BLVD
BRANDON SD
57005-1652
US

IV. Provider business mailing address

7901 E MAPLE ST
BRANDON SD
57005-1104
US

V. Phone/Fax

Practice location:
  • Phone: 605-530-0057
  • Fax:
Mailing address:
  • Phone: 605-530-0057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License NumberR039173
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: