Healthcare Provider Details

I. General information

NPI: 1750497145
Provider Name (Legal Business Name): FOUR SEASONS FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 HARRISON ST
PRINCETON WV
24740-3011
US

IV. Provider business mailing address

PO BOX 1050
PRINCETON WV
24740-1050
US

V. Phone/Fax

Practice location:
  • Phone: 304-431-7100
  • Fax: 304-431-7112
Mailing address:
  • Phone: 304-431-7100
  • Fax: 304-431-7112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16854
License Number StateWV

VIII. Authorized Official

Name: NANCY A LOHUIS
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 304-431-7100