Healthcare Provider Details

I. General information

NPI: 1164192464
Provider Name (Legal Business Name): VILDANA MASIC ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 04/17/2025
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ DIV IM HOSPITALIST
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-1700
  • Fax: 314-362-9878
Mailing address:
  • Phone: 314-362-1700
  • Fax: 314-362-9878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2021046368
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: