Healthcare Provider Details

I. General information

NPI: 1609611128
Provider Name (Legal Business Name): INTEGRATIVE GLOBAL MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1247 KAAHUMANU ST STE 221
AIEA HI
96701-5310
US

IV. Provider business mailing address

98-1247 KAAHUMANU ST STE 221
AIEA HI
96701-5310
US

V. Phone/Fax

Practice location:
  • Phone: 808-435-8808
  • Fax:
Mailing address:
  • Phone: 808-435-8808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ELAINE ANTONE
Title or Position: MANAGER
Credential:
Phone: 808-435-8808