Provider Demographics
NPI:1669453734
Name:TROUT, CRISTINA W (NP,RN,MSN)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:W
Last Name:TROUT
Suffix:
Gender:F
Credentials:NP,RN,MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:901 PLANTATION RD
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-3833
Practice Address - Country:US
Practice Address - Phone:540-951-0352
Practice Address - Fax:540-951-7724
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001090521163W00000X
VA0122000219247100000X
VA0024090521363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7781199Medicaid
500000134Medicare PIN
VA7781199Medicaid
VA500000134Medicare ID - Type Unspecified
VA017930C18Medicare PIN