Healthcare Provider Details

I. General information

NPI: 1396565313
Provider Name (Legal Business Name): SHALEM WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 W ALDER ST STE 342
WALLA WALLA WA
99362-2849
US

IV. Provider business mailing address

240 W CHESTNUT ST
WALLA WALLA WA
99362-4057
US

V. Phone/Fax

Practice location:
  • Phone: 509-200-4864
  • Fax:
Mailing address:
  • Phone: 509-200-4864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SARAH ELIZABETH RUDE
Title or Position: OWNER/PRESCRIBER
Credential: DNP-PMHNP,ARNP
Phone: 509-200-4864