Healthcare Provider Details

I. General information

NPI: 1992360119
Provider Name (Legal Business Name): CELESTE MARIAH ECHEVARRIA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 WARWICKSHIRE DR
GREENSBORO NC
27455-2207
US

IV. Provider business mailing address

2006 WARWICKSHIRE DR
GREENSBORO NC
27455-2207
US

V. Phone/Fax

Practice location:
  • Phone: 980-253-5136
  • Fax: 336-530-1130
Mailing address:
  • Phone: 980-253-5136
  • Fax: 336-530-1130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001011044
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number001011044
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: