Healthcare Provider Details

I. General information

NPI: 1144145392
Provider Name (Legal Business Name): LILLY SEAVEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 TUCKER RD NE
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

3204 N MOUNTAIN VIEW DR
FARMINGTON NM
87401-4012
US

V. Phone/Fax

Practice location:
  • Phone: 800-690-0934
  • Fax:
Mailing address:
  • Phone: 505-721-0560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number129542653102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: