MEDICARE: MENERVA YOLE-LOBE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	390200000X	Student in an Organized Health Care Education/Training Program
3	363A00000X	Physician Assistant	11989340-1206	UT

General Provider Information

NPI Number	:	1215285374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MENERVA YOLE-LOBE

Provider Business Mailing Address
First Line	:	158 W THISTLE DR
Second Line	:
City	:	SARATOGA SPRINGS
State	:	UT
Zip	:	84045-6592
Country	:	US
Telephone Number	:	775-544-3111
Fax Number	:

Provider Business Practice Location Address
First Line	:	3690 S MAIN ST
Second Line	:
City	:	SOUTH SALT LAKE
State	:	UT
Zip	:	84115-4423
Country	:	US
Telephone Number	:	801-587-2525
Fax Number	:	801-261-0503

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2012
Last Update Date	:	08/27/2023

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