Provider Demographics
NPI:1316821689
Name:EROMOSELE, ELIZABETH OMONMENE (APRN, PMHNP- BC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:OMONMENE
Last Name:EROMOSELE
Suffix:
Gender:F
Credentials:APRN, PMHNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 PENDRYN HILL ALCOVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-7702
Mailing Address - Country:US
Mailing Address - Phone:651-587-7322
Mailing Address - Fax:
Practice Address - Street 1:213 PENDRYN HILL ALCOVE
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-7702
Practice Address - Country:US
Practice Address - Phone:651-587-7322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13164363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health