MEDICARE: LANCE CROTTY LPN

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
1	164W00000X	Licensed Practical Nurse	42371	WV

General Provider Information

NPI Number	:	1790629434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANCE CROTTY LPN

Provider Business Mailing Address
First Line	:	307 N 3RD ST
Second Line	:
City	:	PRINCETON
State	:	WV
Zip	:	24740-3329
Country	:	US
Telephone Number	:	304-692-2335
Fax Number	:

Provider Business Practice Location Address
First Line	:	307 N 3RD ST
Second Line	:
City	:	PRINCETON
State	:	WV
Zip	:	24740-3329
Country	:	US
Telephone Number	:	304-692-2335
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2026
Last Update Date	:	04/15/2026

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Directions to “ LANCE CROTTY LPN” Practice Location

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