Healthcare Provider Details

I. General information

NPI: 1417167149
Provider Name (Legal Business Name): JUDITH ANN CROUTHAMEL RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 10/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 DELP RD
SOUDERTON PA
18964-2147
US

IV. Provider business mailing address

521 DELP RD
SOUDERTON PA
18964-2147
US

V. Phone/Fax

Practice location:
  • Phone: 610-584-6111
  • Fax:
Mailing address:
  • Phone: 610-584-6111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN264895L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: