MEDICARE: MS. MARA CLARK YOLKEN ANP

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	363LA2200X	Adult Health Nurse Practitioner	11089	CA

General Provider Information

NPI Number	:	1972724003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARA CLARK YOLKEN ANP

Provider Business Mailing Address
First Line	:	153 PIONEER LN # B
Second Line	:	RURAL HEALTH CLINIC
City	:	BISHOP
State	:	CA
Zip	:	93514-2557
Country	:	US
Telephone Number	:	760-873-2849
Fax Number	:	760-873-2836

Provider Business Practice Location Address
First Line	:	153 PIONEER LN # B
Second Line	:	RURAL HEALTH CLINIC
City	:	BISHOP
State	:	CA
Zip	:	93514-2557
Country	:	US
Telephone Number	:	760-873-2849
Fax Number	:	760-873-2836

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/08/2007

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