Provider Demographics
NPI:1215285374
Name:YOLE-LOBE, MENERVA
Entity type:Individual
Prefix:
First Name:MENERVA
Middle Name:
Last Name:YOLE-LOBE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 W THISTLE DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-6592
Mailing Address - Country:US
Mailing Address - Phone:775-544-3111
Mailing Address - Fax:
Practice Address - Street 1:3690 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84115-4423
Practice Address - Country:US
Practice Address - Phone:801-587-2525
Practice Address - Fax:801-261-0503
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2023-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 390200000X
UT11989340-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program