Healthcare Provider Details

I. General information

NPI: 1508185687
Provider Name (Legal Business Name): NANCY WILLIGER PHD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 05/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 OLD FRONTENAC SQ STE 201
SAINT LOUIS MO
63131-2755
US

IV. Provider business mailing address

745 OLD FRONTENAC SQ STE 201
SAINT LOUIS MO
63131-2755
US

V. Phone/Fax

Practice location:
  • Phone: 314-993-4001
  • Fax: 314-993-5424
Mailing address:
  • Phone: 314-993-4001
  • Fax: 314-993-5424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number01336
License Number StateMO

VIII. Authorized Official

Name: NANCY R WILLIGER
Title or Position: PRESIDENT/OWNER
Credential: PHD
Phone: 314-993-4001