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General NPI Number Information
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NPI Number | 1780739847
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Entity Type | Individual
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Provider Name | ANYA MICHELLE ANTHONY P.A.C.
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Gender | Female
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 11/04/2010
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Provider Practice Location Address
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Address Line | 166 SOUTH 5TH
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City | MONTPELIER
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State | ID
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Zip | 83254-4959
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Country | US
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Telephone | 208-847-3847
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Fax | 208-847-1620
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Provider Business Mailing Address
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Address Line | 166 SOUTH 5TH
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City | MONTPELIER
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State | ID
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Zip | 83254-1557
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Country | US
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Telephone | 208-847-3847
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Fax | 208-847-1620
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA18630
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License Number State | CA
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