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Individual

MONDRAKUS HARPER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
12565 EVENING SHADE DR, BLACK JACK, MO 63033-8513
(314) 583-1477
(314) 216-3926
Mailing address
12565 EVENING SHADE DR, BLACK JACK, MO 63033-8513
(314) 583-1477
(314) 216-3926

Taxonomy

Speciality
Code
Description
License number
State
246RP1900X
Phlebotomy Technician
Primary
B6P44F8Q3
KY
376K00000X
Nurse's Aide
134849
MO

Other

Enumeration date
03/13/2023
Last updated
03/13/2023
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