Healthcare Provider Details

I. General information

NPI: 1841628047
Provider Name (Legal Business Name): TI-YON WARD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2013
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8135 CALUMET AVE
MUNSTER IN
46321-1701
US

IV. Provider business mailing address

8135 CALUMET AVE
MUNSTER IN
46321-1701
US

V. Phone/Fax

Practice location:
  • Phone: 219-513-2000
  • Fax: 219-764-3251
Mailing address:
  • Phone: 219-513-2000
  • Fax: 219-764-3251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71004733A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: