Provider Demographics
NPI:1831756188
Name:SCHILLE, COLTON R (MPH, RD, LDN)
Entity type:Individual
Prefix:
First Name:COLTON
Middle Name:R
Last Name:SCHILLE
Suffix:
Gender:M
Credentials:MPH, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337A BURKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-3940
Mailing Address - Country:US
Mailing Address - Phone:253-359-8486
Mailing Address - Fax:
Practice Address - Street 1:337A BURKEWOOD DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-3940
Practice Address - Country:US
Practice Address - Phone:253-359-8486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005146133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered