Provider Demographics
NPI:1164250791
Name:GRAVES, LOURDES ZARSOZO
Entity type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:ZARSOZO
Last Name:GRAVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57950 LEAVENWORTH MCCONNELL AFB
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67230-9604
Mailing Address - Country:US
Mailing Address - Phone:316-209-4273
Mailing Address - Fax:
Practice Address - Street 1:57950 LEAVENWORTH MCCONNELL AFB
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67221
Practice Address - Country:US
Practice Address - Phone:316-759-2083
Practice Address - Fax:316-759-6030
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS42602163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management