Provider Demographics
NPI:1821481946
Name:SFAR, MARAYA DAWN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARAYA
Middle Name:DAWN
Last Name:SFAR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:MARAYA
Other - Middle Name:DAWN
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:921 14TH AVE
Mailing Address - Street 2:COWLITZ COUNTY GUIDANCE ASSOCIATION
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2316
Mailing Address - Country:US
Mailing Address - Phone:360-423-0203
Mailing Address - Fax:360-423-2311
Practice Address - Street 1:921 14TH AVE
Practice Address - Street 2:COWLITZ COUNTY GUIDANCE ASSOCIATION
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2316
Practice Address - Country:US
Practice Address - Phone:360-423-0203
Practice Address - Fax:360-423-2311
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00053915164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1980903Medicaid