Healthcare Provider Details

I. General information

NPI: 1881210706
Provider Name (Legal Business Name): AMANDA WILKMAN, NP PSYCHIATRIC NURSING, REMEDIUM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N SEPULVEDA BLVD STE 210
MANHATTAN BEACH CA
90266-5973
US

IV. Provider business mailing address

206 15TH ST APT B
MANHATTAN BEACH CA
90266-4695
US

V. Phone/Fax

Practice location:
  • Phone: 310-372-9900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMANDA WILKMAN
Title or Position: PRESIDENT
Credential: PMHNP-BC
Phone: 310-372-9900