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NPI Code Detail

MEDICARE: EVELYN CROTTY

MEDICARE: EVELYN CROTTY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LW0102XWomen's Health Nurse Practitioner0024055001VA

General Provider Information

NPI Number : 1295735264
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVELYN CROTTY
Provider Business Mailing Address
First Line : 4706 COURTHOUSE RD
Second Line :
City : PRINCE GEORGE
State : VA
Zip : 23875-3139
Country : US
Telephone Number : 804-732-6223
Fax Number :
Provider Business Practice Location Address
First Line : 301 HALIFAX ST
Second Line :
City : PETERSBURG
State : VA
Zip : 23803-6335
Country : US
Telephone Number : 804-863-1652
Fax Number : 804-863-1608
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2005
Last Update Date : 07/08/2007

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Directions to “ EVELYN CROTTY ” Practice Location

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