Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Professional |
101YP2500X |
| NPI # | 1669985057 |
| LBN Legal business name | BROKEN WING'S MINISTRY INC. |
| Authorized official | TAMMY CARVALHO - (PRESIDENT) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 11/08/2017 |
| Last updated | 11/08/2017 - About 9 years ago |
| Identifiers | n/a |
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