Provider Demographics
NPI:1669280731
Name:TYRYFTER, AUSTEN
Entity type:Individual
Prefix:
First Name:AUSTEN
Middle Name:
Last Name:TYRYFTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-5550
Mailing Address - Country:US
Mailing Address - Phone:701-429-3058
Mailing Address - Fax:
Practice Address - Street 1:1327 CHERRY ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-5550
Practice Address - Country:US
Practice Address - Phone:701-429-3058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR47646163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse