Provider Demographics
NPI:1730603291
Name:BULLINGER, HANNAH BIANCA (PA)
Entity type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:BIANCA
Last Name:BULLINGER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2904 RAVINE DR APT 203
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-2642
Mailing Address - Country:US
Mailing Address - Phone:810-705-0107
Mailing Address - Fax:
Practice Address - Street 1:1075 SUNCREST DR
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-4403
Practice Address - Country:US
Practice Address - Phone:810-705-0107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601008279363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant