Healthcare Provider Details

I. General information

NPI: 1427259183
Provider Name (Legal Business Name): FANTA C SACCOH LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 LANCASTER AVE
WILMINGTON DE
19805-5232
US

IV. Provider business mailing address

630 S BROWNLEAF RD
NEWARK DE
19713-3554
US

V. Phone/Fax

Practice location:
  • Phone: 302-467-1778
  • Fax:
Mailing address:
  • Phone: 302-230-6828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0013810
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: