Healthcare Provider Details

I. General information

NPI: 1558288837
Provider Name (Legal Business Name): ALEXANDRA DEDICATORIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 E KING ST
LANCASTER PA
17602-3111
US

IV. Provider business mailing address

625 E KING ST
LANCASTER PA
17602-3111
US

V. Phone/Fax

Practice location:
  • Phone: 717-299-7800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP036276
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: