Provider Demographics
NPI:1316216369
Name:HAMSTRA, ASHLEY ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:ANNE
Last Name:HAMSTRA
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 1:2151 N MAIN ST STE 248
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-5773
Mailing Address - Country:US
Mailing Address - Phone:843-822-5550
Mailing Address - Fax:
Practice Address - Street 1:421 E LAKESIDE AVE STE 105
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2848
Practice Address - Country:US
Practice Address - Phone:208-277-9704
Practice Address - Fax:208-277-9704
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM13198207ND0900X, 207N00000X
WAMD60630664207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology