Healthcare Provider Details

I. General information

NPI: 1457144347
Provider Name (Legal Business Name): CARMELIA HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8115 N JOSEPH AVE
MILWAUKEE WI
53224-2613
US

IV. Provider business mailing address

8115 N JOSEPH AVE
MILWAUKEE WI
53224-2613
US

V. Phone/Fax

Practice location:
  • Phone: 414-430-2556
  • Fax: 414-430-2556
Mailing address:
  • Phone: 414-430-2556
  • Fax: 414-430-2556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: