Provider Demographics
NPI:1346794278
Name:ROLFSEN, KIM (CRNA)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:
Last Name:ROLFSEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:ROLFSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1633 MAIN ST STE A219
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-4037
Mailing Address - Country:US
Mailing Address - Phone:352-215-3399
Mailing Address - Fax:
Practice Address - Street 1:1901 CLINCH AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2307
Practice Address - Country:US
Practice Address - Phone:865-331-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30204367500000X
MT176614367500000X
FL2502242367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered