Provider Demographics
NPI:1124127790
Name:HINEMAN, ASHLEY LYNN MATROSE (MD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LYNN MATROSE
Last Name:HINEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6635 W HAPPY VALLEY RD STE A104-503
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-2609
Mailing Address - Country:US
Mailing Address - Phone:623-362-1818
Mailing Address - Fax:623-362-8095
Practice Address - Street 1:21681 N 77TH AVE STE 1410
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2133
Practice Address - Country:US
Practice Address - Phone:623-362-1818
Practice Address - Fax:623-362-8095
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33560208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ933780Medicaid