Provider Demographics
NPI:1841092046
Name:NIESE, BRIDGETTE (RN)
Entity type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:
Last Name:NIESE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8028 CARNEGIE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-5788
Practice Address - Country:US
Practice Address - Phone:260-425-6650
Practice Address - Fax:260-755-6233
Is Sole Proprietor?:No
Enumeration Date:2025-03-26
Last Update Date:2025-07-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN28236136A163W00000X
IN09000504A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse