Provider Demographics
NPI:1780336859
Name:MOULTON, CAMRYN SCHWAB (RD)
Entity type:Individual
Prefix:
First Name:CAMRYN
Middle Name:SCHWAB
Last Name:MOULTON
Suffix:
Gender:F
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 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-685-3333
Mailing Address - Fax:614-366-0345
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:614-685-3333
Practice Address - Fax:614-366-0345
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.10294133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO86092255OtherCOMMISSION ON DIETETIC REGISTRATION