Provider Demographics
NPI:1164930533
Name:BROOKSIDE HEALTH & WELLNESS LLC
Entity Type:Organization
Organization Name:BROOKSIDE HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:FRIEND-LANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:301-616-6333
Mailing Address - Street 1:14689 GARRETT HWY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-4059
Mailing Address - Country:US
Mailing Address - Phone:301-334-5610
Mailing Address - Fax:888-843-8457
Practice Address - Street 1:14689 GARRETT HWY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-4059
Practice Address - Country:US
Practice Address - Phone:301-334-5610
Practice Address - Fax:888-843-8457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-18
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR174165363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty