Individual
FANTA C SACCOH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2801 LANCASTER AVE, WILMINGTON, DE 19805-5232
(302) 467-1778
Mailing address
630 S BROWNLEAF RD, NEWARK, DE 19713-3554
(302) 230-6828
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L2-0009395
DE
363LF0000X
Family Nurse Practitioner
Primary
LG-0013810
DE
Other
Enumeration date
05/30/2007
Last updated
05/01/2026
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