NPI Code Detail JSON Logo

1164930533 NPI number — BROOKSIDE HEALTH & WELLNESS LLC

NPI Number: 1164930533
Health Care Provider/Practitioner: BROOKSIDE HEALTH & WELLNESS LLC

Information about “1164930533” NPI (BROOKSIDE HEALTH & WELLNESS LLC) exists in 1164930533 in HTML format HTML  |  1164930533 in plain Text format TXT  |  1164930533 in PDF (Portable Document Format) PDF  |  1164930533 in an XML format XML  formats.

NPI Number : 1164930533 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1164930533",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "BROOKSIDE HEALTH & 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": "PO BOX 654",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "OAKLAND",
    "MailingAddressStateName": "MD",
    "MailingAddressPostalCode": "21550-4654",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "301-334-5610",
    "MailingAddressFaxNumber": "888-843-8457",
    "FirstLinePracticeLocationAddress": "6500 THAYER CTR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "OAKLAND",
    "PracticeLocationAddressStateName": "MD",
    "PracticeLocationAddressPostalCode": "21550-1130",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "301-334-5610",
    "PracticeLocationAddressFaxNumber": "888-843-8457",
    "EnumerationDate": "01/18/2018",
    "LastUpdateDate": "10/16/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "FRIEND-LANTZ",
    "AuthorizedOfficialFirstName": "RACHEL",
    "AuthorizedOfficialMiddleName": "RENEE",
    "AuthorizedOfficialTitle": "CRNP",
    "AuthorizedOfficialNamePrefix": "MRS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "CRNP",
    "AuthorizedOfficialTelephoneNumber": "301-616-6333",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LF0000X",
        "TaxonomyName": "Family Nurse Practitioner",
        "LicenseNumber": "R174165",
        "LicenseNumberStateCode": "MD",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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