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General NPI Number Information
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NPI Number | 1477412328
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Entity Type | Organization
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Legal Business Name | ANNA GUNDERSON INTEGRATIVE MEDICINE
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Dates
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Enumeration Date | 01/16/2026
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Last Update Date | 01/23/2026
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Provider Practice Location Address
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Address Line | 1510 RIVER MEADOWS DR
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City | VICTOR
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State | ID
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Zip | 83455-4795
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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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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 |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANNA M GUNDERSON
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Credential | PA-C
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Telephone | 208-783-3115
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 202D00000X
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Taxonomy Name | Integrative Medicine Physician
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License Number |
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License Number State |
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