Individual
THERESE VIVAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
919 CONESTOGA RD BLDG 1, BRYN MAWR, PA 19010-1352
(610) 525-6580
Mailing address
814 CRESTVIEW RD, PHILADELPHIA, PA 19128-2303
(267) 761-8890
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
SP030615
PA
Other
Enumeration date
09/09/2024
Last updated
09/09/2024
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