Healthcare Provider Details

I. General information

NPI: 1700573151
Provider Name (Legal Business Name): RONALD LEE LOMBARD AGPCNP-BC, DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 NE MONROE ST STE 904
PEORIA IL
61602-1066
US

IV. Provider business mailing address

222 NE MONROE ST
PEORIA IL
61602-1090
US

V. Phone/Fax

Practice location:
  • Phone: 309-224-5621
  • Fax:
Mailing address:
  • Phone: 309-671-8484
  • Fax: 309-680-8611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209027108
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number209027108
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: