MEDICARE: MISS RUTH BOSIRE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SA2100X	Acute Care Clinical Nurse Specialist	AP124766	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	680964	OTHER	TX	TNB LICENSE

General Provider Information

NPI Number	:	1336564103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS RUTH BOSIRE NP

Provider Business Mailing Address
First Line	:	15800 DOOLEY RD
Second Line	:	SUITE 185
City	:	ADDISON
State	:	TX
Zip	:	75001-4284
Country	:	US
Telephone Number	:	972-661-2273
Fax Number	:	866-292-6489

Provider Business Practice Location Address
First Line	:	15800 DOOLEY RD
Second Line	:	SUITE 185
City	:	ADDISON
State	:	TX
Zip	:	75001-4284
Country	:	US
Telephone Number	:	972-661-2273
Fax Number	:	866-292-6489

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2014
Last Update Date	:	02/18/2015

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