Provider Demographics
NPI:1609468396
Name:LUFHOLM, TYLER (APRN)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:LUFHOLM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2735 PEMBROOK PL
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-7482
Mailing Address - Country:US
Mailing Address - Phone:785-537-4990
Mailing Address - Fax:785-537-1938
Practice Address - Street 1:2509 W 18TH AVE
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-6105
Practice Address - Country:US
Practice Address - Phone:620-341-9335
Practice Address - Fax:620-208-9335
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5379915071363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily