Provider Demographics
NPI:1356850150
Name:OLSEN, KRYZIA NICOLE SANTOS (ND, LAC)
Entity Type:Individual
Prefix:
First Name:KRYZIA
Middle Name:NICOLE SANTOS
Last Name:OLSEN
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 NE REVERE AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4059
Mailing Address - Country:US
Mailing Address - Phone:503-738-1535
Mailing Address - Fax:855-461-3309
Practice Address - Street 1:335 NE REVERE AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4059
Practice Address - Country:US
Practice Address - Phone:503-738-1535
Practice Address - Fax:855-461-3309
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC184850171100000X
OR4101175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist