Healthcare Provider Details

I. General information

NPI: 1962031666
Provider Name (Legal Business Name): IAN MATHEW MORLOCK NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2020
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5387 MANHATTAN CIR
BOULDER CO
80303-4284
US

IV. Provider business mailing address

541 COLLEGE ST
BOULDER CO
80302-8713
US

V. Phone/Fax

Practice location:
  • Phone: 303-494-7773
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberRN-1632168
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1000158-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: