MEDICARE: ASHLEY LYNN MATROSE HINEMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	33560	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124127790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY LYNN MATROSE HINEMAN M.D.

Provider Business Mailing Address
First Line	:	6635 W HAPPY VALLEY RD STE A104-503
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85310-2609
Country	:	US
Telephone Number	:	623-362-1818
Fax Number	:	623-362-8095

Provider Business Practice Location Address
First Line	:	21681 N 77TH AVE STE 1410
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-2133
Country	:	US
Telephone Number	:	623-362-1818
Fax Number	:	623-362-8095

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	05/24/2023

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