Individual
LILLIAN CONNIE BOSIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
1500 S MAIN ST, FORT WORTH, TX 76104-4917
(817) 702-1100
Mailing address
PO BOX 732973, DALLAS, TX 75373-2973
(817) 918-5204
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
959213
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
1176514
TX
Other
Enumeration date
07/22/2024
Last updated
06/04/2025
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