Healthcare Provider Details

I. General information

NPI: 1821974809
Provider Name (Legal Business Name): BRITTANY CHRISTINE GONGWER MSN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTANY CHRISTINE KAMP RN

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HIGH PARK AVE
GOSHEN IN
46526-4810
US

IV. Provider business mailing address

57024 COUNTY ROAD 23
GOSHEN IN
46528-9559
US

V. Phone/Fax

Practice location:
  • Phone: 574-364-1000
  • Fax:
Mailing address:
  • Phone: 574-333-5086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4704380406
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number28243078A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: