MEDICARE: GRACE SEBELLA

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	71017901A	IN
2	207Q00000X	Family Medicine Physician	71017901A	IN

General Provider Information

NPI Number	:	1477491900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE SEBELLA

Provider Business Mailing Address
First Line	:	9371 N 408 E
Second Line	:
City	:	LAKE VILLAGE
State	:	IN
Zip	:	46349-9248
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 N 26TH ST
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47904-2895
Country	:	US
Telephone Number	:	866-682-5539
Fax Number	:

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

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	04/09/2026

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Directions to “ GRACE SEBELLA ” Practice Location

Language	Start Address	Practice Location

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