Provider Demographics
NPI:1619080801
Name:TROUT, MARTHA J (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:J
Last Name:TROUT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MISS
Other - First Name:MARTHA
Other - Middle Name:J
Other - Last Name:FOERSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:817 N IRVING CIR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-1911
Mailing Address - Country:US
Mailing Address - Phone:520-326-2087
Mailing Address - Fax:
Practice Address - Street 1:3601 S 6TH AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85723-0001
Practice Address - Country:US
Practice Address - Phone:520-629-1847
Practice Address - Fax:520-629-4745
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43549367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered