Roy Grant Ibrado

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

195948-30 Issued in WI

Practice address

3124 S Taylor Ave
Milwaukee, WI 53207-2724

Phone

(414) 617-7053

NPI assigned

Apr 19, 2014

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Roy Czarnecki Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1397865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564531200000",
    "number": "1114347937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3925 S 1ST ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532074301",
            "telephone_number": "414-617-7053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3124 S TAYLOR AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532072724",
            "telephone_number": "414-617-7053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBRADO",
        "first_name": "ROY",
        "middle_name": "GRANT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-04-19",
        "last_updated": "2019-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "195948-30",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ROY",
            "last_name": "CZARNECKI",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Registered Nurse in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Registered Nurse in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.