=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083535272
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAMILLUS WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2026
-----------------------------------------------------
Last Update Date | 07/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1121 N COLLEGE PARK ST
-----------------------------------------------------
City | DERBY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67037-3665
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-788-3376
-----------------------------------------------------
Fax | 316-788-3378
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1121 N COLLEGE PARK ST
-----------------------------------------------------
City | DERBY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67037-3665
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-788-3376
-----------------------------------------------------
Fax | 316-788-3378
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LORI FALCONE
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 316-788-3376
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------