Individual provider · Type 1 NPI

Derek Shaune Grantham

Student in an Organized Health Care Education/Training Program · Pocatello, ID

NPI number 1487485546 Active

Practice location

921 S 8th Ave Stop 8253
Pocatello, ID 83209-0002

Call (208) 282-4726 Map

Mailing address

1689 W Shoreline Dr Apt 225
Boise, ID 83702-6761

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1487485546

Derek Shaune Grantham's National Provider Identifier is 1487485546, issued on Aug 12, 2024. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Pocatello, ID. The record was last updated on Sep 16, 2026.