MEDICARE: PRISM HEALTH PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1235084005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRISM HEALTH PLLC

Provider Business Mailing Address
First Line	:	795 ELETSON DR
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-2812
Country	:	US
Telephone Number	:	815-571-7588
Fax Number	:	815-571-7589

Provider Business Practice Location Address
First Line	:	795 ELETSON DR
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-2812
Country	:	US
Telephone Number	:	815-571-7588
Fax Number	:	815-571-7589

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	TANA LOMBARDO
Credential	:	APRN
Telephone Number	:	630-715-3088

Provider Enumeration Date	:	02/26/2026
Last Update Date	:	03/19/2026

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