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1396565313 NPI number — SHALEM WELLNESS LLC

NPI Number: 1396565313
Health Care Provider/Practitioner: SHALEM WELLNESS LLC

Information about “1396565313” NPI (SHALEM WELLNESS LLC) exists in 1396565313 in HTML format HTML  |  1396565313 in plain Text format TXT  |  1396565313 in PDF (Portable Document Format) PDF  |  1396565313 in an XML format XML  formats.

NPI Number : 1396565313 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1396565313",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "SHALEM WELLNESS LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "240 W CHESTNUT ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WALLA WALLA",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "99362-4057",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "509-200-4864",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5 W ALDER ST STE 342",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WALLA WALLA",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "99362-2849",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "509-200-4864",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/15/2024",
    "LastUpdateDate": "10/15/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "RUDE",
    "AuthorizedOfficialFirstName": "SARAH",
    "AuthorizedOfficialMiddleName": "ELIZABETH",
    "AuthorizedOfficialTitle": "OWNER/PRESCRIBER",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DNP-PMHNP,ARNP",
    "AuthorizedOfficialTelephoneNumber": "509-200-4864",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "2084P0802X",
          "TaxonomyName": "Addiction Psychiatry Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084P0804X",
          "TaxonomyName": "Child & Adolescent Psychiatry Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084P0805X",
          "TaxonomyName": "Geriatric Psychiatry Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084P0800X",
          "TaxonomyName": "Psychiatry Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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