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General NPI Number Information
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NPI Number | 1083250864
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Entity Type | Individual
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Provider Name | TABITHA NYABOKE BOSIRE CNP
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Gender | Female
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Dates
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Enumeration Date | 11/27/2019
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 2150 HOSPITAL DR
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City | WINDOM
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State | MN
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Zip | 56101-1287
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Country | US
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Telephone | 507-831-2400
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Fax | 507-847-1119
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Provider Business Mailing Address
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Address Line | 2150 HOSPITAL DR
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City | WINDOM
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State | MN
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Zip | 56101-1287
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Country | US
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Telephone | 507-831-2400
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Fax | 507-847-1119
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5379573-072
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2020019972
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 11296
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License Number State | MN
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