Individual provider Active NPI

Sylvia Chitom Nnamdi-Enwerem

  • Psychiatric/Mental Health Nurse Practitioner
  • Grand Forks, ND
National Provider Identifier
1205653755
Registry record updated Oct 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
12195 Issued in MN
Practice address
1200 S Columbia Rd
Grand Forks, ND 58201-4044
Phone
(701) 740-7497
NPI assigned
Sep 25, 2024
Last updated
Oct 17, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 12195 MN Primary

Addresses

Primary practice location

1200 S Columbia Rd
Grand Forks, ND 58201-4044

Mailing address

1200 S Columbia Rd
Grand Forks, ND 58201-4044
Phone (701) 740-7497

Other names 1

  • Mrs. Sylvia Chitom Nnamdi Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241210001591 MN Practitioner - Nurse Practitioner 0345776605 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Alluma IncGroup PAC ID 6709787609, 23 clinicians

Practice addresses (Care Compare)

603 Bruce St
Crookston, MN 56716-2914
Phone (218) 281-3940

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
12195MNMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Alluma, Inc. CurrentSince Oct 30, 2024 Accepting new patients

Locations

603 Bruce St
Crookston, MN 56716
Phone (218) 281-3940

1422 Central Ave NE
East Grand Forks, MN 56721
Phone (218) 773-6102

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1727222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729123200000",
    "number": "1205653755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 S COLUMBIA RD",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014044",
            "telephone_number": "701-740-7497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 S COLUMBIA RD",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014044",
            "telephone_number": "701-740-7497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NNAMDI-ENWEREM",
        "first_name": "SYLVIA",
        "middle_name": "CHITOM",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-25",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "12195",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SYLVIA",
            "last_name": "NNAMDI",
            "middle_name": "CHITOM",
            "prefix": "MRS.",
            "credential": "APRN, PMHNP-BC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Grand Forks, ND

Sources for this page

Verify at the official NPI Registry.