=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598185191
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLE SARAH ROCKWELL JEDERLINIC DO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2014
-----------------------------------------------------
Last Update Date | 03/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12 UNION ST
-----------------------------------------------------
City | ROCKLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04841-2739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-701-4400
-----------------------------------------------------
Fax | 207-701-4487
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 UNION ST
-----------------------------------------------------
City | ROCKLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04841-2739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-292-0111
-----------------------------------------------------
Fax | 207-701-4487
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 34.012476
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | DO3501
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2084P0804X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatry Physician
-----------------------------------------------------
License Number | 34.012476
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 2084P0804X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatry Physician
-----------------------------------------------------
License Number | DO3501
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------