Healthcare Provider Details

I. General information

NPI: 1659295756
Provider Name (Legal Business Name): UPLIFT WALLA WALLA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 SAGAMORE PL
WALLA WALLA WA
99362-5564
US

IV. Provider business mailing address

1380 SAGAMORE PL
WALLA WALLA WA
99362-5564
US

V. Phone/Fax

Practice location:
  • Phone: 707-367-0291
  • Fax:
Mailing address:
  • Phone: 707-367-0291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EMILY CASTILLO
Title or Position: OWNER
Credential:
Phone: 707-367-0291