Provider Demographics
NPI:1336564103
Name:BOSIRE, RUTH (NP)
Entity type:Individual
Prefix:MISS
First Name:RUTH
Middle Name:
Last Name:BOSIRE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15800 DOOLEY RD
Mailing Address - Street 2:SUITE 185
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4284
Mailing Address - Country:US
Mailing Address - Phone:972-661-2273
Mailing Address - Fax:866-292-6489
Practice Address - Street 1:15800 DOOLEY RD
Practice Address - Street 2:SUITE 185
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-4284
Practice Address - Country:US
Practice Address - Phone:972-661-2273
Practice Address - Fax:866-292-6489
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-03
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP124766364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX680964OtherTNB LICENSE