Healthcare Provider Details

I. General information

NPI: 1356256747
Provider Name (Legal Business Name): MADISON KATE TUPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8025 GRAND AVE
WEST DES MOINES IA
50266-5360
US

IV. Provider business mailing address

3603 JASMINE LN
WAUKEE IA
50263-3518
US

V. Phone/Fax

Practice location:
  • Phone: 515-271-1569
  • Fax:
Mailing address:
  • Phone: 319-327-6543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: