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General NPI Number Information
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NPI Number | 1306750815
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Entity Type | Organization
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Legal Business Name | NANJO GROUP LLC - DEVINE MOBILE CLINIC
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Dates
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Enumeration Date | 10/01/2026
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Last Update Date | 10/01/2026
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Provider Practice Location Address
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Address Line | 703 WILDEL AVE
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City | NEW CASTLE
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State | DE
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Zip | 19720-6146
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Country | US
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Telephone | 302-379-7760
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Fax | 833-468-5180
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Provider Business Mailing Address
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Address Line | 703 WILDEL AVE
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City | NEW CASTLE
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State | DE
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Zip | 19720-6146
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Country | US
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Telephone | 302-379-7760
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Fax | 833-468-5180
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Authorized Official
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Title or Position | DNP, FNP-C
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Name | MARY MBABE NANJO-ALLICOCK
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Credential |
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Telephone | 302-379-7760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State | NULL
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