Healthcare Provider Details

I. General information

NPI: 1891783056
Provider Name (Legal Business Name): JEAN BASNIGHT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEAN TSCHUSCHKE DO

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 06/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 E MAIN ST
HAVELOCK NC
28532
US

IV. Provider business mailing address

110 STAFFORDSHIRE DRIVE
NEW BERN NC
28562-8441
US

V. Phone/Fax

Practice location:
  • Phone: 252-447-7474
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number2007-01959
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200701959
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: