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General NPI Number Information
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NPI Number | 1295718328
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Entity Type | Individual
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Provider Name | LESLIE DANESE KAMMIRE MD
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Gender | Female
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Dates
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Enumeration Date | 11/22/2005
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Last Update Date | 07/26/2010
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Provider Practice Location Address
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Address Line | 500 SHEPHERD ST
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City | WINSTON SALEM
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State | NC
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Zip | 27103-1628
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Country | US
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Telephone | 336-716-2255
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 344
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City | WINSTON SALEM
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State | NC
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Zip | 27102-0344
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Country | US
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Telephone | 336-716-2255
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 32122
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 32122
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License Number State | NC
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