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1487485546
DEREK SHAUNE GRANTHAM
POCATELLO, ID
NPI
1487485546
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date
2024-08-12
Last Update Date
2024-08-12
Business Address
Mr. DEREK SHAUNE GRANTHAM
921 S 8TH AVE STOP 8253
POCATELLO, ID 83209-0002
Phone number: 208-282-4726
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Mailing Address
Mr. DEREK SHAUNE GRANTHAM
921 S 8TH AVE STOP 8253
POCATELLO, ID 83209-0002
Phone number: 208-282-4726
Copy
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