Individual
LANE TUPA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
700 W FOREST AVE FL 5, JACKSON, TN 38301-3937
(731) 541-3755
Mailing address
12100 RAINWOOD RD APT 38, LITTLE ROCK, AR 72212-3936
(870) 678-3141
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
08/05/2024
Last updated
04/09/2025
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