Provider Demographics
NPI:1609534270
Name:TYRYFTER, ALISSA KRISTINE
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:KRISTINE
Last Name:TYRYFTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALISSA
Other - Middle Name:KRISTINE
Other - Last Name:TYRYFTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LEGAL LAST NAME
Mailing Address - Street 1:1010 2ND AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-8226
Mailing Address - Country:US
Mailing Address - Phone:701-241-5927
Mailing Address - Fax:
Practice Address - Street 1:1010 2ND AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-8226
Practice Address - Country:US
Practice Address - Phone:701-241-5927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator