Provider Demographics
NPI:1558614412
Name:HANHAM-CAIN, CONNIE (RN, BSN, CDE)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:HANHAM-CAIN
Suffix:
Gender:F
Credentials:RN, BSN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:501 NEW KARNER RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-3882
Practice Address - Country:US
Practice Address - Phone:518-452-1337
Practice Address - Fax:518-724-6660
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY424562163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03501397Medicaid
NYR56361OtherEMPIRE BLUECROSS BLUESHIELD
NY9414935OtherAETNA