Provider Demographics
NPI:1457944225
Name:VIVIS, WALTER GLENN JR
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:GLENN
Last Name:VIVIS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:MCKEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15132-2726
Mailing Address - Country:US
Mailing Address - Phone:412-672-3400
Mailing Address - Fax:412-672-3456
Practice Address - Street 1:500 MARKET ST
Practice Address - Street 2:
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15132-2726
Practice Address - Country:US
Practice Address - Phone:412-672-3400
Practice Address - Fax:412-672-3456
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist