Provider Demographics
NPI:1205653755
Name:NNAMDI-ENWEREM, SYLVIA CHITOM
Entity type:Individual
Prefix:MRS
First Name:SYLVIA
Middle Name:CHITOM
Last Name:NNAMDI-ENWEREM
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SYLVIA
Other - Middle Name:CHITOM
Other - Last Name:NNAMDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, PMHNP-BC
Mailing Address - Street 1:1200 S COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4044
Mailing Address - Country:US
Mailing Address - Phone:701-740-7497
Mailing Address - Fax:
Practice Address - Street 1:1200 S COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4044
Practice Address - Country:US
Practice Address - Phone:701-740-7497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12195363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health