Provider Demographics
NPI:1972724003
Name:YOLKEN, MARA CLARK (ANP)
Entity type:Individual
Prefix:MS
First Name:MARA
Middle Name:CLARK
Last Name:YOLKEN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 PIONEER LN # B
Mailing Address - Street 2:RURAL HEALTH CLINIC
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-2557
Mailing Address - Country:US
Mailing Address - Phone:760-873-2849
Mailing Address - Fax:760-873-2836
Practice Address - Street 1:153 PIONEER LN # B
Practice Address - Street 2:RURAL HEALTH CLINIC
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-2557
Practice Address - Country:US
Practice Address - Phone:760-873-2849
Practice Address - Fax:760-873-2836
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11089363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health