Healthcare Provider Details

I. General information

NPI: 1891624599
Provider Name (Legal Business Name): JENNIFER MARIE MADDOCKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 WALDO AVE APT 2
BELFAST ME
04915-6932
US

IV. Provider business mailing address

219 WALDO AVE APT 2
BELFAST ME
04915-6932
US

V. Phone/Fax

Practice location:
  • Phone: 207-215-2236
  • Fax:
Mailing address:
  • Phone: 207-215-2236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN57791
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: