Healthcare Provider Details

I. General information

NPI: 1770494924
Provider Name (Legal Business Name): MIMI GRACE PLUMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7344 S DUPONT HWY STE 6
FELTON DE
19943-5715
US

IV. Provider business mailing address

20277 CUBBAGE POND RD
LINCOLN DE
19960-2701
US

V. Phone/Fax

Practice location:
  • Phone: 302-212-4873
  • Fax:
Mailing address:
  • Phone: 302-393-4044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberQ3-0011631
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: