Provider Demographics
NPI:1720621501
Name:NANJO-ALLICOCK, MARY MBABE (DNP, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:MBABE
Last Name:NANJO-ALLICOCK
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:MBABE
Other - Last Name:NANJO-ALLICOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, FNP-C
Mailing Address - Street 1:262 CHAPMAN RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5448
Mailing Address - Country:US
Mailing Address - Phone:302-220-7147
Mailing Address - Fax:
Practice Address - Street 1:932 WILDEL AVE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-6151
Practice Address - Country:US
Practice Address - Phone:302-220-7147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0001352363LF0000X
DEF09191511363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily