Healthcare Provider Details

I. General information

NPI: 1730738873
Provider Name (Legal Business Name): RICHARD ONYAIT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4602 EASTPARK BLVD
MADISON WI
53718-2002
US

IV. Provider business mailing address

141 LANSING ST
MADISON WI
53714-2232
US

V. Phone/Fax

Practice location:
  • Phone: 701-329-0306
  • Fax:
Mailing address:
  • Phone: 701-329-0306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number18014-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: