Individual
JESSICA ELDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2212 E GRANTVIEW DR, CORALVILLE, IA 52241-1396
(217) 246-2921
Mailing address
2212 E GRANTVIEW DR, CORALVILLE, IA 52241-1396
(217) 246-2921
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E3075715
EMT-B
—
Enumeration date
09/19/2017
Last updated
07/21/2022
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