Individual
GLORIA D WALZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
1041 MONTGOMERY STREET, CUSTER, SD 57730-1304
(605) 673-4150
(605) 673-3917
Mailing address
353 FAIRMONT BLVD, ATTEN MSS, RAPID CITY, SD 57701-7375
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0270
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
970015058
MEDICARE RAILROAD PTAN
—
Enumeration date
01/19/2006
Last updated
01/23/2013
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