MEDICARE: SARAH ELIZABETH RUDE DNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN60466755	WA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP61085680	WA

General Provider Information

NPI Number	:	1144866856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH ELIZABETH RUDE DNP

Provider Business Mailing Address
First Line	:	103 E MAIN ST STE 301
Second Line	:
City	:	WALLA WALLA
State	:	WA
Zip	:	99362-1900
Country	:	US
Telephone Number	:	509-200-4864
Fax Number	:	509-231-7231

Provider Business Practice Location Address
First Line	:	103 E MAIN ST STE 301
Second Line	:
City	:	WALLA WALLA
State	:	WA
Zip	:	99362-1900
Country	:	US
Telephone Number	:	509-200-4864
Fax Number	:	509-231-7231

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2019
Last Update Date	:	05/14/2026

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