MEDICARE: CARRIE DASTRUP BA LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	4478-S	NV

General Provider Information

NPI Number	:	1447462544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE DASTRUP BA LSW

Provider Business Mailing Address
First Line	:	4495 W HACIENDA AVE STE 7
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1541
Country	:	US
Telephone Number	:	702-374-3294
Fax Number	:

Provider Business Practice Location Address
First Line	:	4495 W HACIENDA AVE STE 7
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1541
Country	:	US
Telephone Number	:	702-385-5331
Fax Number	:	702-385-5678

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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Practice Location Address:

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