Provider Demographics
NPI:1336450295
Name:HARDESTY VAN GINKEL, ASHLEE BREANNA (MD)
Entity Type:Individual
Prefix:
First Name:ASHLEE
Middle Name:BREANNA
Last Name:HARDESTY VAN GINKEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ASHLEE
Other - Middle Name:BREANNA
Other - Last Name:HARDESTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:345 BLACKSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4800
Mailing Address - Country:US
Mailing Address - Phone:401-455-6375
Mailing Address - Fax:401-455-6497
Practice Address - Street 1:345 BLACKSTONE BLVD
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4800
Practice Address - Country:US
Practice Address - Phone:401-455-6375
Practice Address - Fax:401-455-6497
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP020482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry