Healthcare Provider Details

I. General information

NPI: 1417276239
Provider Name (Legal Business Name): MR. ELLIOTT A. PLOURDE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 05/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 LINAPUNI ST SUITE 105
HONOLULU HI
96819-3575
US

IV. Provider business mailing address

1485 LINAPUNI ST SUITE 105
HONOLULU HI
96819-3575
US

V. Phone/Fax

Practice location:
  • Phone: 808-843-5312
  • Fax: 808-848-2069
Mailing address:
  • Phone: 808-843-5312
  • Fax: 808-848-2069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: