Healthcare Provider Details

I. General information

NPI: 1912823253
Provider Name (Legal Business Name): TIFFANY LORRAINE DIETSCH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 W FAIR AVE
MARQUETTE MI
49855-2675
US

IV. Provider business mailing address

325 E H ST
IRON MOUNTAIN MI
49801-4760
US

V. Phone/Fax

Practice location:
  • Phone: 906-774-3300
  • Fax: 906-226-5317
Mailing address:
  • Phone: 906-774-3300
  • Fax: 906-226-5317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number4704296897
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: