Gail Prosser, RD, CDE

Primary specialty

Pediatric Nutrition Registered DietitianTaxonomy code 133VN1004X

License

017009 Issued in CA

Practice address

3925 Old Redwood Hwy
Dept of Pediatrics
Santa Rosa, CA 95403-1719

Phone

(707) 566-5358

Fax

(707) 566-5292

NPI assigned

Dec 12, 2006

Last updated

Feb 11, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Patricia Gail Prosser Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644537600000",
    "number": "1083775365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3925 OLD REDWOOD HWY",
            "address_2": "DEPT OF PEDIATRICS",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954031719",
            "telephone_number": "707-566-5358",
            "fax_number": "707-566-5292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3925 OLD REDWOOD HWY",
            "address_2": "DEPT OF PEDIATRICS",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954031719",
            "telephone_number": "707-566-5358",
            "fax_number": "707-566-5292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROSSER",
        "first_name": "GAIL",
        "name_prefix": "Ms.",
        "credential": "RD, CDE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-12",
        "last_updated": "2022-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1004X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Pediatric",
            "state": "CA",
            "license": "017009",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "401 Bicentennial Wy",
            "city": "Santa Rosa",
            "state": "CA",
            "country_code": "US",
            "postal_code": "95403",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "PATRICIA",
            "last_name": "PROSSER",
            "middle_name": "GAIL",
            "credential": "RD, CDE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Providence Medical Foundation
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• Erin Stephanie Prucha, M.S.O.M, L.AC.

• Pediatric Nutrition Registered Dietitian in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Pediatric Nutrition Registered Dietitian in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.