Healthcare Provider Details

I. General information

NPI: 1699608208
Provider Name (Legal Business Name): DEVINE MOBILE MEDICAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 LANCASTER AVENUE SUIT E
WILMINGTON DE
19805
US

IV. Provider business mailing address

20 PENN MART CTR
NEW CASTLE DE
19720-4207
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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