Individual
DR. MARILYN J WALLER-NIEWOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.P.M.
Contact information
Practice address
1270 KOT-NUM ROAD, BOX 1209, WARM SPRINGS, OR 98861
(541) 553-1196
(541) 553-2613
Mailing address
1270 KOT-NUM ROAD, BOX 1209, WARM SPRINGS, OR 98861
(541) 553-1196
(541) 553-2613
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
DP00352
OR
213ES0103X
Foot & Ankle Surgery Podiatrist
E3808
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0407825
—
CA
05
—
273855
—
OR
Enumeration date
05/27/2005
Last updated
06/14/2011
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