Healthcare Provider Details

I. General information

NPI: 1174635817
Provider Name (Legal Business Name): LORETTA A HOTHERSALL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 US ROUTE 1 STE J
SCARBOROUGH ME
04074-7168
US

IV. Provider business mailing address

71 US ROUTE 1 STE J
SCARBOROUGH ME
04074-7168
US

V. Phone/Fax

Practice location:
  • Phone: 207-396-6433
  • Fax: 207-396-6436
Mailing address:
  • Phone: 207-396-6433
  • Fax: 207-396-6436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR033570
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: