Provider Demographics
NPI:1760638977
Name:NETHERLAND, JUDITH ANN (LAC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:NETHERLAND
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1353 LOOP 332
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-4211
Mailing Address - Country:US
Mailing Address - Phone:512-515-0551
Mailing Address - Fax:512-515-0551
Practice Address - Street 1:1353 LOOP 332
Practice Address - Street 2:
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-4211
Practice Address - Country:US
Practice Address - Phone:512-515-0551
Practice Address - Fax:512-515-0551
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00474171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist