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General NPI Number Information
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NPI Number | 1376544924
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Entity Type | Individual
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Provider Name | DEREK SEBADE ANPC
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Gender | Male
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Dates
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Enumeration Date | 08/04/2005
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Last Update Date | 12/21/2012
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Provider Practice Location Address
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Address Line | 20040 N 19TH AVE SUITE A
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City | PHOENIX
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State | AZ
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Zip | 85027-4255
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Country | US
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Telephone | 623-869-5000
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Fax | 623-869-0927
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Provider Business Mailing Address
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Address Line | 20040 N 19TH AVE SUITE A
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City | PHOENIX
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State | AZ
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Zip | 85027-4255
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Country | US
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Telephone | 623-869-5000
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Fax | 623-869-0927
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | RN082334
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License Number State | AZ
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