Provider Demographics
NPI:1659661379
Name:DEROOS, ASHLEY LYNN (CNA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LYNN
Last Name:DEROOS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7878 SPENCER HWY
Mailing Address - Street 2:NUMBER 4
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-1939
Mailing Address - Country:US
Mailing Address - Phone:281-743-1776
Mailing Address - Fax:
Practice Address - Street 1:7878 SPENCER HWY
Practice Address - Street 2:NUMBER 4
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-1939
Practice Address - Country:US
Practice Address - Phone:281-743-1776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA08704960374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide