Provider Demographics
NPI:1316114317
Name:CANNESTRA, LESLIE M
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:M
Last Name:CANNESTRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7823 W VERONA CT
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53219-3861
Mailing Address - Country:US
Mailing Address - Phone:414-727-5403
Mailing Address - Fax:
Practice Address - Street 1:W261S8347 FAULKNER RD
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-8519
Practice Address - Country:US
Practice Address - Phone:414-839-3763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2021-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3147-026174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist