Healthcare Provider Details

I. General information

NPI: 1174606107
Provider Name (Legal Business Name): JOHN W. ONSTAD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S 12TH AVE
YAKIMA WA
98902-3142
US

IV. Provider business mailing address

401 S 12TH AVE
YAKIMA WA
98902-3142
US

V. Phone/Fax

Practice location:
  • Phone: 509-248-1831
  • Fax: 509-452-6911
Mailing address:
  • Phone: 509-248-1831
  • Fax: 509-452-6911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberMD00014553
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD00014553
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: