Healthcare Provider Details

I. General information

NPI: 1104455989
Provider Name (Legal Business Name): ASHLEY MARIE MULDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASHLEY MARIE DESMARAIS M.D.

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 MESQUITE AVE
LAKE HAVASU CITY AZ
86403-5894
US

IV. Provider business mailing address

2035 MESQUITE AVE
LAKE HAVASU CITY AZ
86403-5894
US

V. Phone/Fax

Practice location:
  • Phone: 928-208-4598
  • Fax: 888-571-6436
Mailing address:
  • Phone: 928-208-4598
  • Fax: 888-571-6436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number69006
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: