Provider Demographics
NPI:1780336859
Name:MOULTON, CAMRYN SCHWAB (RD)
Entity type:Individual
Prefix:
First Name:CAMRYN
Middle Name:SCHWAB
Last Name:MOULTON
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:CAMRYN
Other - Middle Name:
Other - Last Name:SCHWAB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:543 TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43203-1278
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:543 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203-1278
Practice Address - Country:US
Practice Address - Phone:804-955-8848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86092255133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO86092255OtherCOMMISSION ON DIETETIC REGISTRATION