Provider Demographics
NPI:1861605271
Name:WASHINGTON UNIVERSITY
Entity type:Organization
Organization Name:WASHINGTON UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF RESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:NATIVIDAD
Authorized Official - Last Name:IGNACIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-229-7944
Mailing Address - Street 1:3278 JANUARY AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-1743
Mailing Address - Country:US
Mailing Address - Phone:314-229-7944
Mailing Address - Fax:
Practice Address - Street 1:4444 FOREST PARK AVE
Practice Address - Street 2:CAMPUS BOX 8518
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2212
Practice Address - Country:US
Practice Address - Phone:314-445-7757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004015125283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital