Healthcare Provider Details

I. General information

NPI: 1306757893
Provider Name (Legal Business Name): ADRIANA GRISEL PRIETO GRAVE DE PERALTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 HARRISBURG PIKE STE 202
LANCASTER PA
17601-2644
US

IV. Provider business mailing address

2112 HARRISBURG PIKE STE 202
LANCASTER PA
17601-2644
US

V. Phone/Fax

Practice location:
  • Phone: 717-869-4600
  • Fax:
Mailing address:
  • Phone: 717-869-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP037140
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: