Healthcare Provider Details

I. General information

NPI: 1326998105
Provider Name (Legal Business Name): JUNE MIYOKO HENLEY-MEYER I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2026
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3821 INDIAN BUTTE CT
MODESTO CA
95355-3686
US

IV. Provider business mailing address

3821 INDIAN BUTTE CT
MODESTO CA
95355-3686
US

V. Phone/Fax

Practice location:
  • Phone: 209-602-3755
  • Fax:
Mailing address:
  • Phone: 209-602-3755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number315199
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: