Healthcare Provider Details

I. General information

NPI: 1346100229
Provider Name (Legal Business Name): EXCALIBUR PSYCHIATRIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3412 CENTER POINT RD NE
CEDAR RAPIDS IA
52402-5575
US

IV. Provider business mailing address

1324 LINDENBROOK LN
MARION IA
52302-4783
US

V. Phone/Fax

Practice location:
  • Phone: 319-382-8660
  • Fax:
Mailing address:
  • Phone: 720-446-6987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: AMANDA WISIAN
Title or Position: PSYCHIATRIC NURSE PRACTITIONER
Credential: PMHNP-BC, LPC, NCC
Phone: 720-446-6987