Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | G159114 | IA |
NPI | 1033730916 |
---|---|
Provider Name | Julie Trout |
First Address | Gilbert, IA 50105-0115 |
Second Address | Ames, IA 50010-5745 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2020 |
Last Update Date | 25/03/2021 |