Healthcare Provider Details

I. General information

NPI: 1740199256
Provider Name (Legal Business Name): DIANE TUPPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 N IRISH RD
DAVISON MI
48423-2209
US

IV. Provider business mailing address

435 CHARING CROSS DR
GRAND BLANC MI
48439-1570
US

V. Phone/Fax

Practice location:
  • Phone: 810-771-3457
  • Fax:
Mailing address:
  • Phone: 336-409-6515
  • 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 StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: