Healthcare Provider Details

I. General information

NPI: 1255965539
Provider Name (Legal Business Name): TING-WAN YIP WORDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 US HIGHWAY 27 N
MARSHALL MI
49068-9609
US

IV. Provider business mailing address

720 US HIGHWAY 27 N
MARSHALL MI
49068-9609
US

V. Phone/Fax

Practice location:
  • Phone: 269-781-6600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number20325104107
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number4704280802
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: