=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265091771
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. MARILEE AGNES PLATZEK
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2019
-----------------------------------------------------
Last Update Date | 12/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 965 HIGHWAY 431
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36274-7329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-863-2141
-----------------------------------------------------
Fax | 334-863-8733
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9676 COUNTY ROAD 56
-----------------------------------------------------
City | WOODLAND
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36280-7216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-885-0050
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 1-097212
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------