Marilyn J Waller-Niewold, D.P.M.

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

DP00352 Issued in OR

Practice address

1270 Kot-Num Road, Box 1209
Warm Springs, OR 98861

Phone

(541) 553-1196

Fax

(541) 553-2613

NPI assigned

May 27, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Dr. Marilyn J Waller Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Confederated Tribes of the Warm Springs Reservation of Oregon

  • Clinic/Center
  • Warm Springs, OR
  • NPI 1700027927
  NPD (past)

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

{
    "created_epoch": "1117152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308009600000",
    "number": "1568465177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1270 KOT-NUM ROAD, BOX 1209",
            "city": "WARM SPRINGS",
            "state": "OR",
            "postal_code": "98861",
            "telephone_number": "541-553-1196",
            "fax_number": "541-553-2613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1270 KOT-NUM ROAD, BOX 1209",
            "city": "WARM SPRINGS",
            "state": "OR",
            "postal_code": "98861",
            "telephone_number": "541-553-1196",
            "fax_number": "541-553-2613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER-NIEWOLD",
        "first_name": "MARILYN",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-05-27",
        "last_updated": "2011-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "OR",
            "license": "DP00352",
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "CA",
            "license": "E3808",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0407825",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "273855",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARILYN",
            "last_name": "WALLER",
            "middle_name": "J",
            "prefix": "DR.",
            "credential": "D.P.M.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Denise Swift, R.N.
• Vincent Joaquin Tavalez, PHARMD
• The Confederated Tribes of the Warm Springs Reservation of Oregon
• Hai Tuan Tran, DPM
• Roberta Carol Villa, RN
• Joanne Wallis, ANP
• Diana Jaye Wambaugh, NURSE PRACTITIONER
• Warm Springs Health and Wellness Center
• Warm Springs Health and Wellness Center
• Warm Springs Health and Wellness Center

• Foot & Ankle Surgery Podiatrist in Warm Springs, OR
• Providers in Warm Springs, OR by specialty
• Foot & Ankle Surgery Podiatrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2011; 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.