Healthcare Provider Details

I. General information

NPI: 1174407670
Provider Name (Legal Business Name): CHELSEA JANE HEUSINGER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSEA JANE MEDLIN

II. Dates (important events)

Enumeration Date: 08/05/2025
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W 27TH ST
LUMBERTON NC
28358-3075
US

IV. Provider business mailing address

126 LEACH CREEK DR
RAEFORD NC
28376-4204
US

V. Phone/Fax

Practice location:
  • Phone: 910-671-5000
  • Fax:
Mailing address:
  • Phone: 252-908-5845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number306722
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: