Healthcare Provider Details

I. General information

NPI: 1801533179
Provider Name (Legal Business Name): WINNIE J BOSIRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N HOWARD ST STE W
SPOKANE WA
99201-0508
US

IV. Provider business mailing address

1301 E DEBBIE LN STE 102
MANSFIELD TX
76063-3376
US

V. Phone/Fax

Practice location:
  • Phone: 817-225-5781
  • Fax:
Mailing address:
  • Phone: 214-210-2846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1075225
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61528370
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1075225
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: