Provider Demographics
NPI:1245236249
Name:WARE, LESLIE ANN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:ANN
Last Name:WARE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:LESLIE
Other - Middle Name:ANN
Other - Last Name:WARE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 786
Mailing Address - Street 2:
Mailing Address - City:MT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-0786
Mailing Address - Country:US
Mailing Address - Phone:704-822-6200
Mailing Address - Fax:704-822-3598
Practice Address - Street 1:305 W CATAWBA AVE
Practice Address - Street 2:
Practice Address - City:MT HOLLY
Practice Address - State:NC
Practice Address - Zip Code:28120-1613
Practice Address - Country:US
Practice Address - Phone:704-822-6200
Practice Address - Fax:704-822-3598
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103472363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC4619AMedicare PIN