Healthcare Provider Details

I. General information

NPI: 1083535272
Provider Name (Legal Business Name): CAMILLUS WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 N COLLEGE PARK ST
DERBY KS
67037-3665
US

IV. Provider business mailing address

1121 N COLLEGE PARK ST
DERBY KS
67037-3665
US

V. Phone/Fax

Practice location:
  • Phone: 316-788-3376
  • Fax: 316-788-3378
Mailing address:
  • Phone: 316-788-3376
  • Fax: 316-788-3378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: LORI FALCONE
Title or Position: OWNER
Credential: APRN
Phone: 316-788-3376