Healthcare Provider Details

I. General information

NPI: 1609717396
Provider Name (Legal Business Name): RACHEL BLANTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2026
Last Update Date: 04/04/2026
Certification Date: 04/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13401 FOUNTAIN CLUB DR
GERMANTOWN MD
20874-2124
US

IV. Provider business mailing address

13401 FOUNTAIN CLUB DR APT 201
GERMANTOWN MD
20874-2133
US

V. Phone/Fax

Practice location:
  • Phone: 240-676-1399
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR229931
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: