Healthcare Provider Details

I. General information

NPI: 1902724438
Provider Name (Legal Business Name): LILLY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 COUNTRY CLUB DR SE APT G
RIO RANCHO NM
87124-2205
US

IV. Provider business mailing address

909 COUNTRY CLUB DR SE APT G
RIO RANCHO NM
87124-2205
US

V. Phone/Fax

Practice location:
  • Phone: 505-930-0369
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DONNETTE PUSEY
Title or Position: OWNER
Credential:
Phone: 505-930-0369