Provider Demographics
NPI:1720504954
Name:KOHLMEIER, LEANNE SUE (APRN)
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:SUE
Last Name:KOHLMEIER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 AMENDMENT AVE # 102
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3036
Mailing Address - Country:US
Mailing Address - Phone:803-329-2700
Mailing Address - Fax:
Practice Address - Street 1:4705 SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217
Practice Address - Country:US
Practice Address - Phone:980-247-6288
Practice Address - Fax:704-525-6384
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21255208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty