Healthcare Provider Details

I. General information

NPI: 1942662572
Provider Name (Legal Business Name): JIMENA ANABEL REPETTO FRENETTE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JIMENA ANABEL REPETTO MD

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1885 PLAZA DR
EAGAN MN
55122-2979
US

IV. Provider business mailing address

8170 33RD AVE S # MS 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-4001
  • Fax: 952-993-4095
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number73312
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA163319
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: