=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245196070
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COREWELL DME INNOVATIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/24/2025
-----------------------------------------------------
Last Update Date | 12/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7150 20TH ST STE M
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32966-8899
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-824-9384
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7150 20TH ST STE M
-----------------------------------------------------
City | VERO BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32966-8899
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-824-9384
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER
-----------------------------------------------------
Name | ALEXANDRA WAGNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 901-824-9384
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------