Provider Demographics
NPI:1043985948
Name:FONSECA, BRIDGET (RN)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGET
Middle Name:
Last Name:FONSECA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MANNING RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01949-1526
Mailing Address - Country:US
Mailing Address - Phone:978-750-1900
Mailing Address - Fax:
Practice Address - Street 1:20 MANNING RD
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:MA
Practice Address - Zip Code:01949-1526
Practice Address - Country:US
Practice Address - Phone:978-750-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN233421163WA0400X
MARN2333421163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN2333421OtherBOARD OF REGISTRY