Provider Demographics
NPI:1972929446
Name:GUNDERSON, ANGI RUTHANN
Entity Type:Individual
Prefix:MRS
First Name:ANGI
Middle Name:RUTHANN
Last Name:GUNDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 S CRESTWOOD DR NE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-8967
Mailing Address - Country:US
Mailing Address - Phone:320-766-9239
Mailing Address - Fax:
Practice Address - Street 1:2809 S CRESTWOOD DR NE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-8967
Practice Address - Country:US
Practice Address - Phone:320-766-9239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-08
Last Update Date:2014-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child