=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669326526
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GLADYS MARIE DESSELLE LC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2026
-----------------------------------------------------
Last Update Date | 02/25/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3300 GALLOWS RD
-----------------------------------------------------
City | FALLS CHURCH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22042-3300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-776-4001
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12405 PROXMIRE DR
-----------------------------------------------------
City | FORT WASHINGTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20744-5238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WL0100X
-----------------------------------------------------
Taxonomy Name | Lactation Consultant (Registered Nurse)
-----------------------------------------------------
License Number | L1-0076517
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------