Provider Demographics
NPI:1700340023
Name:BIEDEBACH, ASHLYN
Entity Type:Individual
Prefix:MRS
First Name:ASHLYN
Middle Name:
Last Name:BIEDEBACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 SWISS AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-6025
Mailing Address - Country:US
Mailing Address - Phone:817-562-2828
Mailing Address - Fax:
Practice Address - Street 1:3100 SWISS AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6025
Practice Address - Country:US
Practice Address - Phone:817-562-2828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-31
Last Update Date:2022-12-28
Deactivation Date:2022-10-06
Deactivation Code:
Reactivation Date:2022-12-08
Provider Licenses
StateLicense IDTaxonomies
TX1095975367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife