| Doctor Name: | SALLY S STOTHOFF |
| NPI Number: | 1366439929 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | R024050 |
| Business Practice Address: | 180 Kennedy Memorial Dr Suite 204 Waterville, ME - 049014540 |
| Business Phone Number: | 2078725529 |
| Business Fax Number: | 2078729219 |
| Mailing Address: | 180 Kennedy Memorial Dr, Suite 204 WATERVILLE |
| State: | ME |
| Postal Code: | 049014540 |
| Phone Number: | 2078725529 |
| Fax Number: | 2078729219 |
| NPI Enumeration Date: | 09/29/2005 |
| NPI Last Update Date: | 05/23/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | R024050 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | ME |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |