Esravila A. Wibisono, MD
Internal Medicine · Bonney Lake, WA
UnclaimedMDNPI 1972233708
- Primary taxonomy
- 207R00000X
- Enumerated
- 2022-06-14
- Practice location
- Bonney Lake, WA
- Last NPPES update
- 2025-07-31
State licenses
- WA · Physician · NPPES self-reportedListed on NPI record
- WA · Physician · Physician And Surgeon LicenseActivethrough 2027
- WA · Physician · Physician And Surgeon Temporary Permit - MDTPInactive
“Listed on NPI record” means the provider reported this license to NPPES; other statuses come from the state board’s public records as of the last import. License numbers are not shown.
Source: CMS National Plan & Provider Enumeration System (NPPES) and state licensing boards. ScrubHub shows name, credential, taxonomy, practice city/state and license status only.