Provider Demographics
NPI:1740874742
Name:GRANTHAM, SARAH (RN, BSN, CLS, NTM)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:GRANTHAM
Suffix:
Gender:F
Credentials:RN, BSN, CLS, NTM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 CRESTON AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50315-1810
Mailing Address - Country:US
Mailing Address - Phone:641-750-6205
Mailing Address - Fax:
Practice Address - Street 1:1219 CRESTON AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50315-1810
Practice Address - Country:US
Practice Address - Phone:641-750-6205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA122992163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse