Individual
SALLY STOCKWELL
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
55 MAIN ST, SUITE 3, ESSEX JUNCTION, VT 05452-3191
(802) 879-1802
(802) 878-6131
Mailing address
723 OAK KNOLL RD, WILLISTON, VT 05495-2053
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
042-0005620
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00002576
BCBS
VT
05
—
0002576
—
VT
01
—
16V015
MVP
VT
01
—
5211101
VERMONT MANAGED CARE
VT
Enumeration date
12/29/2005
Last updated
07/08/2007
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