Provider Demographics
NPI:1063617132
Name:IMONEN, ELODIE SCHAFFER (DO)
Entity type:Individual
Prefix:
First Name:ELODIE
Middle Name:SCHAFFER
Last Name:IMONEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44-2944 KALANIAI RD
Mailing Address - Street 2:
Mailing Address - City:HONOKAA
Mailing Address - State:HI
Mailing Address - Zip Code:96727-6870
Mailing Address - Country:US
Mailing Address - Phone:808-775-0619
Mailing Address - Fax:
Practice Address - Street 1:44-2944 KALANIAI RD
Practice Address - Street 2:
Practice Address - City:HONOKAA
Practice Address - State:HI
Practice Address - Zip Code:96727-6870
Practice Address - Country:US
Practice Address - Phone:808-775-0619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS-6142084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry