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General NPI Number Information
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NPI Number | 1174872345
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Entity Type | Individual
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Provider Name | ANNA MCCAMY GUNDERSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/04/2012
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 120 E HOWARD ST
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City | DRIGGS
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State | ID
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Zip | 83422-5112
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Country | US
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Telephone | 208-354-2302
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Fax | 208-354-2829
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Provider Business Mailing Address
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Address Line | PO BOX 1104
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City | VICTOR
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State | ID
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Zip | 83455-1032
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Country | US
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Telephone | 208-783-3115
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Fax | 800-859-4576
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA-990
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License Number State | ID
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