Healthcare Provider Details

I. General information

NPI: 1225971476
Provider Name (Legal Business Name): REPROHEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 WESTERN AVE N SUITE 8 OFFICE 102
ST PAUL MN
55102-4613
US

IV. Provider business mailing address

165 WESTERN AVE N SUITE 8 OFFICE 102
SAINT PAUL MN
55102-4613
US

V. Phone/Fax

Practice location:
  • Phone: 763-273-3770
  • Fax:
Mailing address:
  • Phone: 763-273-3770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DER VUE
Title or Position: CLINICIAN
Credential: NP
Phone: 763-273-3770