Provider Demographics
NPI:1811728678
Name:CESTARE, LA WANDA
Entity type:Individual
Prefix:
First Name:LA WANDA
Middle Name:
Last Name:CESTARE
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 1:610 N FAYETTEVILLE ST STE 106
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-4671
Mailing Address - Country:US
Mailing Address - Phone:910-687-4888
Mailing Address - Fax:
Practice Address - Street 1:610 N FAYETTEVILLE ST STE 106
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-4671
Practice Address - Country:US
Practice Address - Phone:910-687-4888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5021606208VP0000X
NCF07240799363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine