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1477412328 NPI number — ANNA GUNDERSON INTEGRATIVE MEDICINE

NPI Number: 1477412328
Health Care Provider/Practitioner: ANNA GUNDERSON INTEGRATIVE MEDICINE

Information about “1477412328” NPI (ANNA GUNDERSON INTEGRATIVE MEDICINE) exists in 1477412328 in HTML format HTML  |  1477412328 in plain Text format TXT  |  1477412328 in PDF (Portable Document Format) PDF  |  1477412328 in an XML format XML  formats.

NPI Number : 1477412328 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1477412328",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "ANNA GUNDERSON INTEGRATIVE MEDICINE",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 1104",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "VICTOR",
    "MailingAddressStateName": "ID",
    "MailingAddressPostalCode": "83455-1032",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1510 RIVER MEADOWS DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "VICTOR",
    "PracticeLocationAddressStateName": "ID",
    "PracticeLocationAddressPostalCode": "83455-4795",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "208-783-3115",
    "PracticeLocationAddressFaxNumber": "800-859-4576",
    "EnumerationDate": "01/16/2026",
    "LastUpdateDate": "01/16/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "GUNDERSON",
    "AuthorizedOfficialFirstName": "ANNA",
    "AuthorizedOfficialMiddleName": "M",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PA-C",
    "AuthorizedOfficialTelephoneNumber": "208-783-3115",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363AM0700X",
          "TaxonomyName": "Medical Physician Assistant",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "202D00000X",
          "TaxonomyName": "Integrative Medicine Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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