Healthcare Provider Details

I. General information

NPI: 1730744988
Provider Name (Legal Business Name): CAROLINE SHEA ROLOFSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLINE SUZANNE SHEA

II. Dates (important events)

Enumeration Date: 05/03/2019
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 HIGHLAND AVE STE 2
CLARKSTON WA
99403-2836
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 509-769-2252
  • Fax: 509-769-2253
Mailing address:
  • Phone: 208-343-7501
  • Fax: 208-336-8248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberO-1826
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: