Organization
WELLCARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEREK SEBADE ANP-C (OWNER)
(602) 564-0078
Entity
Organization
Contact information
Practice address
18275 N 59TH AVE STE 138, GLENDALE, AZ 85308-1253
(602) 564-0078
(602) 564-1154
Mailing address
18275 N 59TH AVE STE 138, GLENDALE, AZ 85308-1253
(602) 564-0078
(602) 564-1154
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
082334
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
61944
—
AZ
Enumeration date
07/16/2006
Last updated
08/22/2020
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