Provider Demographics
NPI:1922979608
Name:LAGRADILLA, IANCARLO (BSN, RN)
Entity type:Individual
Prefix:
First Name:IANCARLO
Middle Name:
Last Name:LAGRADILLA
Suffix:
Gender:M
Credentials:BSN, RN
Other - Prefix:
Other - First Name:IAN
Other - Middle Name:
Other - Last Name:LAGRADILLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:711 CHIMNEY ROCK DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-8331
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:711 CHIMNEY ROCK DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89002-8331
Practice Address - Country:US
Practice Address - Phone:702-281-9705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV886944163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health