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General NPI Number Information
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NPI Number | 1164930533
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Entity Type | Organization
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Legal Business Name | BROOKSIDE HEALTH & WELLNESS LLC
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Dates
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Enumeration Date | 01/18/2018
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 6500 THAYER CTR
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City | OAKLAND
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State | MD
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Zip | 21550-1130
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Country | US
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Telephone | 301-334-5610
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Fax | 888-843-8457
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Provider Business Mailing Address
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Address Line | PO BOX 654
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City | OAKLAND
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State | MD
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Zip | 21550-4654
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Country | US
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Telephone | 301-334-5610
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Fax | 888-843-8457
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Authorized Official
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Title or Position | CRNP
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Name | MRS. RACHEL RENEE FRIEND-LANTZ
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Credential | CRNP
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Telephone | 301-616-6333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R174165
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License Number State | MD
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