Healthcare Provider Details

I. General information

NPI: 1811728678
Provider Name (Legal Business Name): LA WANDA CESTARE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N FAYETTEVILLE ST STE 106
ASHEBORO NC
27203-4671
US

IV. Provider business mailing address

610 N FAYETTEVILLE ST STE 106
ASHEBORO NC
27203-4671
US

V. Phone/Fax

Practice location:
  • Phone: 910-687-4888
  • Fax:
Mailing address:
  • Phone: 910-687-4888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number5021606
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF07240799
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: