Provider Demographics
NPI:1134503493
Name:YIP, WINNIE (PMHNP)
Entity Type:Individual
Prefix:
First Name:WINNIE
Middle Name:
Last Name:YIP
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:WINNIE
Other - Middle Name:
Other - Last Name:YIP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1030 MAIN ST NE UNIT 305
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-4407
Mailing Address - Country:US
Mailing Address - Phone:208-570-5204
Mailing Address - Fax:
Practice Address - Street 1:2001 BLOOMINGTON AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3074
Practice Address - Country:US
Practice Address - Phone:612-301-3433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9950363LP0808X
OHCOA.17750-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0320295Medicaid