Provider Demographics
NPI:1598507170
Name:DESROSIERS, DESHAUN YVOINIQUE (CMP,LM)
Entity type:Individual
Prefix:
First Name:DESHAUN
Middle Name:YVOINIQUE
Last Name:DESROSIERS
Suffix:
Gender:F
Credentials:CMP,LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11110 BAMMEL NORTH HOUSTON RD APT C
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77066-5300
Mailing Address - Country:US
Mailing Address - Phone:281-768-1497
Mailing Address - Fax:
Practice Address - Street 1:11110 BAMMEL NORTH HOUSTON RD APT C
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77066-5300
Practice Address - Country:US
Practice Address - Phone:281-768-1497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty