Provider Demographics
NPI:1669441408
Name:PROSSER, ROBYN L (RD, CDE)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:L
Last Name:PROSSER
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:ROBYN
Other - Middle Name:L
Other - Last Name:VIERLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CDE
Mailing Address - Street 1:1010 N COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-3309
Mailing Address - Country:US
Mailing Address - Phone:480-461-2409
Mailing Address - Fax:
Practice Address - Street 1:1300 N 12TH ST
Practice Address - Street 2:SUITE 610
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2848
Practice Address - Country:US
Practice Address - Phone:602-239-5000
Practice Address - Fax:602-239-3339
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ861901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ719338Medicaid
AZZ78199Medicare PIN
P56207Medicare UPIN
AZZ123005Medicare PIN
AZ719338Medicaid