Gloria D Walz, CNP

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0270 Issued in SD

Practice address

1041 Montgomery Street
Custer, SD 57730-1304

Phone

(605) 673-4150

Fax

(605) 673-3917

NPI assigned

Jan 19, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358899200000",
    "number": "1326028937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "353 FAIRMONT BLVD",
            "address_2": "ATTEN MSS",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577017375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1041 MONTGOMERY STREET",
            "city": "CUSTER",
            "state": "SD",
            "postal_code": "577301304",
            "telephone_number": "605-673-4150",
            "fax_number": "605-673-3917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALZ",
        "first_name": "GLORIA",
        "middle_name": "D",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-19",
        "last_updated": "2013-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SD",
            "license": "0270",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD PTAN",
            "identifier": "970015058",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Custer, SD
• Providers in Custer, SD by specialty
• Physician Assistant in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.