Healthcare Provider Details

I. General information

NPI: 1700340023
Provider Name (Legal Business Name): MRS. ASHLYN BIEDEBACH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2019
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date: 10/06/2022
Reactivation Date: 12/08/2022

III. Provider practice location address

3100 SWISS AVE
DALLAS TX
75204-6025
US

IV. Provider business mailing address

3100 SWISS AVE
DALLAS TX
75204-6025
US

V. Phone/Fax

Practice location:
  • Phone: 817-562-2828
  • Fax:
Mailing address:
  • Phone: 817-562-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1095975
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: