Provider Demographics
NPI:1801548359
Name:DEROOS, KASHA NICHOLE (LM, CPM)
Entity type:Individual
Prefix:
First Name:KASHA
Middle Name:NICHOLE
Last Name:DEROOS
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5155 W CITRUSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-5197
Mailing Address - Country:US
Mailing Address - Phone:208-500-8777
Mailing Address - Fax:
Practice Address - Street 1:1076 W HAYDEN AVE
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8793
Practice Address - Country:US
Practice Address - Phone:208-772-2823
Practice Address - Fax:208-625-2027
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMID-128175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay