Provider Demographics
NPI:1730744988
Name:ROLOFSON, CAROLINE SHEA (DO)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:SHEA
Last Name:ROLOFSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:SUZANNE
Other - Last Name:SHEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-343-7501
Mailing Address - Fax:208-336-8248
Practice Address - Street 1:100 E IDAHO ST STE 302
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6269
Practice Address - Country:US
Practice Address - Phone:208-343-7501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-03
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IDO-1826207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program