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General NPI Number Information
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NPI Number | 1134076797
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Entity Type | Organization
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Legal Business Name | ELIM DPC PLLC
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Dates
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Enumeration Date | 03/12/2026
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Last Update Date | 03/12/2026
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Provider Practice Location Address
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Address Line | 909 E 2ND AVE STE G
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City | INDIANOLA
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State | IA
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Zip | 50125-2892
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Country | US
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Telephone | 515-316-4128
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Fax |
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Provider Business Mailing Address
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Address Line | 112 S 19TH CT
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City | INDIANOLA
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State | IA
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Zip | 50125-4725
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Country | US
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Telephone | 515-316-4128
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA DEVAULT
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Credential | ARNP
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Telephone | 515-316-4128
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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