Healthcare Provider Details

I. General information

NPI: 1265091771
Provider Name (Legal Business Name): MRS. MARILEE AGNES PLATZEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2019
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 HIGHWAY 431
ROANOKE AL
36274-7329
US

IV. Provider business mailing address

9676 COUNTY ROAD 56
WOODLAND AL
36280-7216
US

V. Phone/Fax

Practice location:
  • Phone: 334-863-2141
  • Fax: 334-863-8733
Mailing address:
  • Phone: 334-885-0050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-097212
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: