Healthcare Provider Details

I. General information

NPI: 1124127790
Provider Name (Legal Business Name): ASHLEY LYNN MATROSE HINEMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21681 N 77TH AVE STE 1410
PEORIA AZ
85382-2133
US

IV. Provider business mailing address

6635 W HAPPY VALLEY RD STE A104-503
GLENDALE AZ
85310-2609
US

V. Phone/Fax

Practice location:
  • Phone: 623-362-1818
  • Fax: 623-362-8095
Mailing address:
  • Phone: 623-362-1818
  • Fax: 623-362-8095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number33560
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: