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General NPI Number Information
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NPI Number | 1124115787
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Entity Type | Individual
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Provider Name | REBECCA SUE ZIMMERMAN NOMELAND D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 06/20/2019
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Provider Practice Location Address
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Address Line | 1313 PENN AVE N
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City | MINNEAPOLIS
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State | MN
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Zip | 55411-3047
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Country | US
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Telephone | 612-543-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 8521 VALLEY VIEW CT
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City | PRIOR LAKE
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State | MN
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Zip | 55372-9766
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Country | US
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Telephone | 952-846-7840
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D11093
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License Number State | MN
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