Provider Demographics
NPI:1518946763
Name:HUBBARD, MARIAMA PATRICIA (NP)
Entity type:Individual
Prefix:MRS
First Name:MARIAMA
Middle Name:PATRICIA
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:MARIAMA
Other - Middle Name:PATRICIA
Other - Last Name:YILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 740021
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-0021
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:773-866-8014
Practice Address - Street 1:3703 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-4846
Practice Address - Country:US
Practice Address - Phone:201-255-0213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-14
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333990-1363LF0000X
NJ26NJ00050800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0046639Medicaid
NJ085606SU7Medicare PIN