Provider Demographics
NPI:1780739847
Name:ANTHONY, ANYA MICHELLE (PAC)
Entity type:Individual
Prefix:MRS
First Name:ANYA
Middle Name:MICHELLE
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:PAC
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Mailing Address - Street 1:166 SOUTH 5TH
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:ID
Mailing Address - Zip Code:83254-1557
Mailing Address - Country:US
Mailing Address - Phone:208-847-3847
Mailing Address - Fax:208-847-1620
Practice Address - Street 1:166 SOUTH 5TH
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:ID
Practice Address - Zip Code:83254-4959
Practice Address - Country:US
Practice Address - Phone:208-847-3847
Practice Address - Fax:208-847-1620
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2010-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA18630363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant