Individual
MRS. MARY GRACE LEGASPI WILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, RN, AGPCNP-BC
Contact information
Practice address
12200 ANNAPOLIS RD STE 115, GLENN DALE, MD 20769-9182
(301) 805-7084
Mailing address
4335 SLATER AVE, NOTTINGHAM, MD 21236-2725
(301) 805-7084
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
R164664
MD
Other
Enumeration date
01/16/2026
Last updated
01/16/2026
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