Provider Demographics
NPI:1518987296
Name:KUFAHL, AMY LYNN (RNFNP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:KUFAHL
Suffix:
Gender:F
Credentials:RNFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2170 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:WINDOM
Mailing Address - State:MN
Mailing Address - Zip Code:56101-1287
Mailing Address - Country:US
Mailing Address - Phone:507-831-2550
Mailing Address - Fax:507-831-5528
Practice Address - Street 1:2170 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WINDOM
Practice Address - State:MN
Practice Address - Zip Code:56101-1287
Practice Address - Country:US
Practice Address - Phone:507-831-2550
Practice Address - Fax:507-831-5528
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1386833363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN80G54CHOtherBCBS MN
MN0121846OtherMEDICA
MNHP57319OtherHEALTH PARTNERS
MN276433400Medicaid
MNQ54620Medicare UPIN
MN276433400Medicaid