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General NPI Number Information
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NPI Number | 1396565313
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Entity Type | Organization
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Legal Business Name | SHALEM WELLNESS LLC
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 5 W ALDER ST STE 342
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City | WALLA WALLA
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State | WA
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Zip | 99362-2849
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Country | US
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Telephone | 509-200-4864
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Fax |
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Provider Business Mailing Address
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Address Line | 240 W CHESTNUT ST
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City | WALLA WALLA
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State | WA
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Zip | 99362-4057
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Country | US
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Telephone | 509-200-4864
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESCRIBER
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Name | DR. SARAH ELIZABETH RUDE
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Credential | DNP-PMHNP,ARNP
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Telephone | 509-200-4864
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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