Provider Demographics
NPI:1417167149
Name:CROUTHAMEL, JUDITH ANN (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:CROUTHAMEL
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 DELP RD
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-2147
Mailing Address - Country:US
Mailing Address - Phone:610-584-6111
Mailing Address - Fax:
Practice Address - Street 1:521 DELP RD
Practice Address - Street 2:
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964-2147
Practice Address - Country:US
Practice Address - Phone:610-584-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2012-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN264895L163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant