Provider Demographics
NPI:1679091136
Name:CISLER, BROOKE MARIE (FNP, PMHNP)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:MARIE
Last Name:CISLER
Suffix:
Gender:F
Credentials:FNP, PMHNP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:MARIE
Other - Last Name:CISLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12 PAUL HOLLY DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12211-1706
Mailing Address - Country:US
Mailing Address - Phone:716-462-0083
Mailing Address - Fax:
Practice Address - Street 1:427 GUY PARK AVE
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-1064
Practice Address - Country:US
Practice Address - Phone:518-842-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF341889-1363LF0000X
NYF403391-01363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily