Healthcare Provider Details

I. General information

NPI: 1679289797
Provider Name (Legal Business Name): PORSHA AMANNI CARSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 N 38TH ST
MILWAUKEE WI
53209-3613
US

IV. Provider business mailing address

6000 N 38TH ST
MILWAUKEE WI
53209-3613
US

V. Phone/Fax

Practice location:
  • Phone: 262-225-8008
  • Fax:
Mailing address:
  • Phone: 262-225-8008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number265455-30
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number265455-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: