Healthcare Provider Details

I. General information

NPI: 1235084005
Provider Name (Legal Business Name): PRISM HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 ELETSON DR
CRYSTAL LAKE IL
60014-2812
US

IV. Provider business mailing address

795 ELETSON DR
CRYSTAL LAKE IL
60014-2812
US

V. Phone/Fax

Practice location:
  • Phone: 815-571-7588
  • Fax: 815-571-7589
Mailing address:
  • Phone: 815-571-7588
  • Fax: 815-571-7589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TANA LOMBARDO
Title or Position: MANAGING MEMBER
Credential: APRN
Phone: 630-715-3088