Healthcare Provider Details

I. General information

NPI: 1124472238
Provider Name (Legal Business Name): JADE EVINK MS, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2016
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 N HARVARD ST
BOSTON MA
02163-1010
US

IV. Provider business mailing address

257 BOYLSTON ST
WATERTOWN MA
02472-4143
US

V. Phone/Fax

Practice location:
  • Phone: 617-495-2200
  • Fax:
Mailing address:
  • Phone: 616-405-3981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2601001304
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: