Provider Demographics
NPI:1639575251
Name:HUNDERMARK, ANNA JEAN (CNIM)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:JEAN
Last Name:HUNDERMARK
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 116
Mailing Address - Street 2:
Mailing Address - City:MILAM
Mailing Address - State:TX
Mailing Address - Zip Code:75959-0116
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:607 10TH ST
Practice Address - Street 2:STE 104
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-5817
Practice Address - Country:US
Practice Address - Phone:720-428-8701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2936246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic