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Individual

MUTIAT B BAMGBALA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PROVIDER

Contact information

Practice address
254 ASHFIELD LN, LEXINGTON, NC 27292-8348
(860) 986-0003
Mailing address
355 FAITH RD, SALISBURY, NC 28146-7007
(860) 986-0003

Taxonomy

Speciality
Code
Description
License number
State
342000000X
Transportation Network Company
000048761695
NC
347C00000X
Private Vehicle
Primary
000048761695
NC

Other

Enumeration date
05/24/2023
Last updated
10/06/2023
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