Individual
TASHA BYNUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNC, IHP, LMT
Contact information
Practice address
N7010 KROGHVILLE RD, WATERLOO, WI 53594-9429
(608) 520-0067
Mailing address
N7010 KROGHVILLE RD, WATERLOO, WI 53594-9429
(608) 520-0067
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
—
—
225700000X
Massage Therapist
Primary
5067-146
WI
Other
Enumeration date
04/08/2025
Last updated
04/08/2025
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