Provider Demographics
NPI:1487540779
Name:BOSIRE, NANCY KWAMBOKA
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:KWAMBOKA
Last Name:BOSIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 BRAUNSTON DR
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-8739
Mailing Address - Country:US
Mailing Address - Phone:085-636-1346
Mailing Address - Fax:
Practice Address - Street 1:2116 E HENRIETTA RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-4518
Practice Address - Country:US
Practice Address - Phone:085-636-1346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY753691163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse