Provider Demographics
NPI:1700573151
Name:LOMBARD, RONALD LEE (AGPCNP-BC, DNP)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LEE
Last Name:LOMBARD
Suffix:
Gender:M
Credentials:AGPCNP-BC, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 W RIDGEMONT RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-7221
Mailing Address - Country:US
Mailing Address - Phone:309-224-5621
Mailing Address - Fax:
Practice Address - Street 1:222 NE MONROE ST STE 904
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602-1066
Practice Address - Country:US
Practice Address - Phone:309-224-5621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209027108363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology