MEDICARE: DR. DESMOND A ATEM DNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP61376005	WA
2	363LF0000X	Family Nurse Practitioner	71013434A	IN
3	363LP2300X	Primary Care Nurse Practitioner	321417	AZ
4	363LF0000X	Family Nurse Practitioner	C-RXN.0002570-C-NP	CO

General Provider Information

NPI Number	:	1720797822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DESMOND A ATEM DNP

Provider Business Mailing Address
First Line	:	9105 E 56TH ST STE J
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46216-2231
Country	:	US
Telephone Number	:	260-508-6088
Fax Number	:	260-344-8964

Provider Business Practice Location Address
First Line	:	9105 E 56TH ST STE J
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46216-2231
Country	:	US
Telephone Number	:	260-508-6088
Fax Number	:	260-344-8964

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2022
Last Update Date	:	03/16/2026

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