Healthcare Provider Details

I. General information

NPI: 1669441408
Provider Name (Legal Business Name): ROBYN L PROSSER R.D., C.D.E.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBYN L VIERLING R.D., C.D.E.

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 N 12TH ST SUITE 610
PHOENIX AZ
85006-2848
US

IV. Provider business mailing address

1010 N COUNTRY CLUB DR
MESA AZ
85201-3309
US

V. Phone/Fax

Practice location:
  • Phone: 602-239-5000
  • Fax: 602-239-3339
Mailing address:
  • Phone: 480-461-2409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number861901
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: