Healthcare Provider Details

I. General information

NPI: 1477412328
Provider Name (Legal Business Name): ANNA GUNDERSON INTEGRATIVE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2026
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 RIVER MEADOWS DR
VICTOR ID
83455-4795
US

IV. Provider business mailing address

PO BOX 1104
VICTOR ID
83455-1032
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: ANNA M GUNDERSON
Title or Position: OWNER
Credential: PA-C
Phone: 208-783-3115