Provider Demographics
NPI:1245028356
Name:MULAC, ANNA KOMER (FNP-BC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:KOMER
Last Name:MULAC
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:KOMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:5249 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4201
Practice Address - Country:US
Practice Address - Phone:757-467-3900
Practice Address - Fax:757-467-7800
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024192681363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily