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General NPI Number Information
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NPI Number | 1295791630
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Entity Type | Organization
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Legal Business Name | FAMILY PRACTICE IN THE WOODS PC
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 11/23/2007
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Provider Practice Location Address
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Address Line | 120 WAUKAZOO DR
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City | HOLLAND
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State | MI
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Zip | 49424-2556
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Country | US
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Telephone | 616-399-9680
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8155
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City | HOLLAND
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State | MI
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Zip | 49422-8155
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LOWELL LAMAR STYER
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Credential | MD
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Telephone | 616-399-9680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704185046
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301048380
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License Number State | MI
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