Healthcare Provider Details

I. General information

NPI: 1306783451
Provider Name (Legal Business Name): CARDIAVIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 THE GRN STE B
DOVER DE
19901-3618
US

IV. Provider business mailing address

8 THE GRN STE B
DOVER DE
19901-3618
US

V. Phone/Fax

Practice location:
  • Phone: 570-575-8607
  • Fax:
Mailing address:
  • Phone: 570-575-8607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE MCGEE
Title or Position: CO-FOUNDER/CEO
Credential: NP
Phone: 570-575-8607