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General NPI Number Information
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NPI Number | 1891223426
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Entity Type | Individual
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Provider Name | CHRISTINA BROCKETT MS, CNS, LDN
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Gender | Female
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Dates
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Enumeration Date | 05/26/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5718 NOTTINGHAM PL
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City | ADAMSTOWN
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State | MD
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Zip | 21710-9473
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Country | US
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Telephone | 301-874-2957
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Fax |
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Provider Business Mailing Address
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Address Line | 5718 NOTTINGHAM PL
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City | ADAMSTOWN
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State | MD
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Zip | 21710-9473
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Country | US
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Telephone | 301-874-2957
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | DX4209
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License Number State | MD
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