Individual provider Active NPI

Elizabeth Omonmene Eromosele, APRN, PMHNP- BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Woodbury, MN
National Provider Identifier
1316821689
Registry record updated Aug 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
13164 Issued in MN
Practice address
213 Pendryn Hill Alcove
Woodbury, MN 55125-7702
Phone
(651) 587-7322
NPI assigned
Aug 1, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 1, 2025

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 13164 MN Primary

Addresses

Primary practice location

213 Pendryn Hill Alcove
Woodbury, MN 55125-7702

Mailing address

213 Pendryn Hill Alcove
Woodbury, MN 55125-7702
Phone (651) 587-7322

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
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.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13164MNMDPsychiatric/Mental Health Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1754006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754006400000",
    "number": "1316821689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 PENDRYN HILL ALCOVE",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551257702",
            "telephone_number": "651-587-7322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 PENDRYN HILL ALCOVE",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551257702",
            "telephone_number": "651-587-7322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EROMOSELE",
        "first_name": "ELIZABETH",
        "middle_name": "OMONMENE",
        "credential": "APRN, PMHNP- BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-08-01",
        "last_updated": "2025-08-01",
        "certification_date": "2025-07-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MN",
            "license": "13164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, MN

Sources for this page

Verify at the official NPI Registry.