Healthcare Provider Details

I. General information

NPI: 1174872345
Provider Name (Legal Business Name): ANNA MCCAMY GUNDERSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS ANNA CHARLOTTE MCCAMY

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E HOWARD ST
DRIGGS ID
83422-5112
US

IV. Provider business mailing address

PO BOX 1104
VICTOR ID
83455-1032
US

V. Phone/Fax

Practice location:
  • Phone: 208-354-2302
  • Fax: 208-354-2829
Mailing address:
  • Phone: 208-783-3115
  • Fax: 800-859-4576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-990
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: