Provider Demographics
NPI:1114745247
Name:CARSON, PORSCHE
Entity type:Individual
Prefix:
First Name:PORSCHE
Middle Name:
Last Name:CARSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24225 W 9 MILE RD # 140-1020
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3962
Mailing Address - Country:US
Mailing Address - Phone:248-762-6375
Mailing Address - Fax:
Practice Address - Street 1:24225 W 9 MILE RD # 140-1020
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-3962
Practice Address - Country:US
Practice Address - Phone:248-762-6375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula