Provider Demographics
NPI:1639843428
Name:BULMAHN, ANNA MARIE (PA)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:BULMAHN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3207 WILLOWCREEK RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-5013
Mailing Address - Country:US
Mailing Address - Phone:219-763-3636
Mailing Address - Fax:
Practice Address - Street 1:3207 WILLOWCREEK RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-5013
Practice Address - Country:US
Practice Address - Phone:219-763-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant