Provider Demographics
NPI:1629487160
Name:DINIUS, DESIRAE LYNN (PAC)
Entity type:Individual
Prefix:
First Name:DESIRAE
Middle Name:LYNN
Last Name:DINIUS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 ELM ST
Mailing Address - Street 2:
Mailing Address - City:HILL CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57745-8911
Mailing Address - Country:US
Mailing Address - Phone:605-574-4470
Mailing Address - Fax:605-574-2352
Practice Address - Street 1:238 ELM ST
Practice Address - Street 2:
Practice Address - City:HILL CITY
Practice Address - State:SD
Practice Address - Zip Code:57745-8911
Practice Address - Country:US
Practice Address - Phone:605-574-4470
Practice Address - Fax:605-574-2352
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDHE# 1461268Medicaid
ND71367Medicaid
NDHE# 1461268Medicaid
ND71367Medicaid