Healthcare Provider Details

I. General information

NPI: 1306750815
Provider Name (Legal Business Name): NANJO GROUP LLC - DEVINE MOBILE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 WILDEL AVE
NEW CASTLE DE
19720-6146
US

IV. Provider business mailing address

703 WILDEL AVE
NEW CASTLE DE
19720-6146
US

V. Phone/Fax

Practice location:
  • Phone: 302-379-7760
  • Fax: 833-468-5180
Mailing address:
  • Phone: 302-379-7760
  • Fax: 833-468-5180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARY MBABE NANJO-ALLICOCK
Title or Position: DNP, FNP-C
Credential:
Phone: 302-379-7760