| Doctor Name: | MRS. ANNA MCCAMY GUNDERSON |
| NPI Number: | 1174872345 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | PA-990 |
| Business Practice Address: | 120 E Howard St Driggs, ID - 834225112 |
| Business Phone Number: | 2083542302 |
| Business Fax Number: | 2083542829 |
| Mailing Address: | 227 N 14th Ave, POCATELLO |
| State: | ID |
| Postal Code: | 832014145 |
| Phone Number: | 8015731517 |
| Fax Number: | |
| NPI Enumeration Date: | 09/04/2012 |
| NPI Last Update Date: | 09/04/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA-990 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |