Healthcare Provider Details

I. General information

NPI: 1639094154
Provider Name (Legal Business Name): KRISTINA J DINAN RN, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

938 N AMES ST
SPEARFISH SD
57783-1702
US

IV. Provider business mailing address

19 LOURIE LN
SPEARFISH SD
57783-1144
US

V. Phone/Fax

Practice location:
  • Phone: 605-580-5306
  • Fax:
Mailing address:
  • Phone: 605-580-5306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT10876
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License NumberSD-RN-R039069
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: