Provider Demographics
NPI:1326756768
Name:SEBASTIAN, LOVELY (MSN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:LOVELY
Middle Name:
Last Name:SEBASTIAN
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4454 S TWINLEAF DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-0987
Mailing Address - Country:US
Mailing Address - Phone:480-352-6277
Mailing Address - Fax:
Practice Address - Street 1:1100 S DOBSON RD STE 105
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-6158
Practice Address - Country:US
Practice Address - Phone:480-386-9708
Practice Address - Fax:480-289-4551
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ282502363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily