MEDICARE: LAURIE SUE NASTAS CCCA

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	231H00000X	Audiologist	1601000272	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	540H001354	OTHER	MI	BCBSM
3	5352130	OTHER		AETNA HMO AND MC
4	640H977751	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1932202314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE SUE NASTAS CCCA

Provider Business Mailing Address
First Line	:	14600 KING RD
Second Line	:	SUITE D
City	:	RIVERVIEW
State	:	MI
Zip	:	48193-7952
Country	:	US
Telephone Number	:	734-486-4444
Fax Number	:	734-486-5555

Provider Business Practice Location Address
First Line	:	14600 KING RD
Second Line	:	SUITE D
City	:	RIVERVIEW
State	:	MI
Zip	:	48193-7952
Country	:	US
Telephone Number	:	734-486-4444
Fax Number	:	734-486-5555

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

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	01/07/2009

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