Healthcare Provider Details

I. General information

NPI: 1033730916
Provider Name (Legal Business Name): JULIE TROUT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIE TARBILL

II. Dates (important events)

Enumeration Date: 05/01/2020
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 DUFF AVE
AMES IA
50010-5745
US

IV. Provider business mailing address

PO BOX 115
GILBERT IA
50105-0115
US

V. Phone/Fax

Practice location:
  • Phone: 515-239-2011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number129946
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG159114
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: