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Individual

SALLY S STOTHOFF

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP

Contact information

Practice address
180 KENNEDY MEMORIAL DR, SUITE 204, WATERVILLE, ME 04901-4540
(207) 872-5529
(207) 872-9219
Mailing address
180 KENNEDY MEMORIAL DR, SUITE 204, WATERVILLE, ME 04901-4540
(207) 872-5529
(207) 872-9219

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
CNP81238
ME
363LF0000X
Family Nurse Practitioner
R024050
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
040915
ANTHEM
ME
05
284350099
ME
01
AA21889
HARVARD PILGRIM HEALTHCA
ME
01
P00066199
RAILROAD MEDICARE
ME
Enumeration date
09/29/2005
Last updated
05/23/2016
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