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General NPI Number Information
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NPI Number | 1568186203
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Entity Type | Individual
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Provider Name | IAN WASHINGTON RD/RDN
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Gender | Male
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Dates
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Enumeration Date | 09/27/2022
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Last Update Date | 09/27/2022
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Provider Practice Location Address
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Address Line | 1465 S GRAND BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63104-1003
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Country | US
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Telephone | 314-577-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 3802 MCREE AVE APT 2E
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City | SAINT LOUIS
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State | MO
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Zip | 63110-2659
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Country | US
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Telephone | 417-372-7151
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1004X
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Taxonomy Name | Pediatric Nutrition Registered Dietitian
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License Number | 2022030219
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License Number State | MO
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