Healthcare Provider Details

I. General information

NPI: 1548174170
Provider Name (Legal Business Name): ELENA CARMEN DIBBLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 MORTON AVE
DES MOINES IA
50316-1647
US

IV. Provider business mailing address

1146 BLACKSTONE LN
PLEASANT HILL IA
50327-8924
US

V. Phone/Fax

Practice location:
  • Phone: 515-263-6050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number139925
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: