Provider Demographics
NPI:1124115787
Name:NOMELAND, REBECCA SUE ZIMMERMAN (DDS)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:SUE ZIMMERMAN
Last Name:NOMELAND
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:SUE
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:8521 VALLEY VIEW CT
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-9766
Mailing Address - Country:US
Mailing Address - Phone:952-846-7840
Mailing Address - Fax:
Practice Address - Street 1:1313 PENN AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-3047
Practice Address - Country:US
Practice Address - Phone:612-543-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11093122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist