Provider Demographics
NPI:1508185687
Name:NANCY WILLIGER PHD LLC
Entity Type:Organization
Organization Name:NANCY WILLIGER PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILLIGER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:314-993-4001
Mailing Address - Street 1:745 OLD FRONTENAC SQ STE 201
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2755
Mailing Address - Country:US
Mailing Address - Phone:314-993-4001
Mailing Address - Fax:314-993-5424
Practice Address - Street 1:745 OLD FRONTENAC SQ STE 201
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2755
Practice Address - Country:US
Practice Address - Phone:314-993-4001
Practice Address - Fax:314-993-5424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01336305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization