MEDICARE: MRS. LOVELY SEBASTIAN MSN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	282502	AZ

General Provider Information

NPI Number	:	1326756768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LOVELY SEBASTIAN MSN, FNP-C

Provider Business Mailing Address
First Line	:	4454 S TWINLEAF DR
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85297-0987
Country	:	US
Telephone Number	:	480-352-6277
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 S DOBSON RD STE 105
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85286-6158
Country	:	US
Telephone Number	:	480-386-9708
Fax Number	:	480-289-4551

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2022
Last Update Date	:	11/14/2022

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