MEDICARE: NANCY KWAMBOKA BOSIRE

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	163W00000X	Registered Nurse	753691	NY

General Provider Information

NPI Number	:	1487540779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY KWAMBOKA BOSIRE

Provider Business Mailing Address
First Line	:	46 BRAUNSTON DR
Second Line	:
City	:	FAIRPORT
State	:	NY
Zip	:	14450-8739
Country	:	US
Telephone Number	:	85-636-1346
Fax Number	:

Provider Business Practice Location Address
First Line	:	2116 E HENRIETTA RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14623-4518
Country	:	US
Telephone Number	:	85-636-1346
Fax Number	:

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

Provider Enumeration Date	:	06/16/2025
Last Update Date	:	06/16/2025

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