Provider Demographics
NPI:1841779485
Name:WISHKO, FUNKE ADEFOPE (MD)
Entity Type:Individual
Prefix:DR
First Name:FUNKE
Middle Name:ADEFOPE
Last Name:WISHKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:FUNKE
Other - Middle Name:
Other - Last Name:ADEFOPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3612 216TH DR SW
Mailing Address - Street 2:
Mailing Address - City:BRIER
Mailing Address - State:WA
Mailing Address - Zip Code:98036-8096
Mailing Address - Country:US
Mailing Address - Phone:470-214-3374
Mailing Address - Fax:
Practice Address - Street 1:12303 NE 130TH LN
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3099
Practice Address - Country:US
Practice Address - Phone:425-544-1000
Practice Address - Fax:425-544-1001
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61283257207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVLL3299OtherNEVADA STATE BOARD OF MEDICAL EXAMINERS