Provider Demographics
NPI:1073950036
Name:DISHAROON, AIMEE A (CPM, LM)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:A
Last Name:DISHAROON
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1689
Mailing Address - Street 2:
Mailing Address - City:KEALAKEKUA
Mailing Address - State:HI
Mailing Address - Zip Code:96750-1689
Mailing Address - Country:US
Mailing Address - Phone:541-761-6730
Mailing Address - Fax:
Practice Address - Street 1:78-6831 ALII DR STE 411
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-5403
Practice Address - Country:US
Practice Address - Phone:808-650-3469
Practice Address - Fax:808-319-2068
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-10156092176B00000X
HIMW-20176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife