Provider Demographics
NPI:1336026178
Name:MYERSON, OLIVIA KRANZ (LAC)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:KRANZ
Last Name:MYERSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 E 12TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5261
Mailing Address - Country:US
Mailing Address - Phone:410-303-9095
Mailing Address - Fax:
Practice Address - Street 1:160 E 12TH ST STE 1
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5261
Practice Address - Country:US
Practice Address - Phone:410-303-9095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002735171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist