Phoutphong Manivong, DNP, ARPN, CRNA
Individual provider Active NPI Certified Registered Nurse Anesthetist · Saint Cloud, MN
NPI 1447130620 · NPPES record last updated Dec 1, 2025
Key facts
- NPI
- 1447130620
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- License
- 156072 (MN)
- Practice address
- 5918 Crestwood CT
Saint Cloud, MN 56301-8850 - Phone
- (320) 493-2757
- NPI assigned
- Sep 6, 2025
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Medicare Care Compare profile
- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Allina Health System
Practice addresses (Care Compare)
303 Catlin St
Buffalo, MN 55313-1947
Phone (763) 427-9980
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251210003859 | MN | Practitioner - Certified Registered Nurse Anesthetist (Crna) | 1456845015 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 156072 | MN | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Allina Health System | Current |
Accepting new patients | |
| Allina Health System | Nurse Anesthetist, Certified Registered | Current |
Accepting new patients |
| St Cloud Outpatient Surgery LTD | Nurse Anesthetist, Certified Registered | Current |
Accepting new patients |
| St Cloud Outpatient Surgery LTD | Current | Accepting new patients | |
| Certified Anesthesia Care, Co. | Nurse Anesthetist, Certified Registered | Current |
Accepting new patients |
Locations
9801 DuPont Ave S
Ste 100
Bloomington, MN 55431
303 Catlin St
Buffalo, MN 55313
Phone (763) 682-1212
1526 Northway Dr
Saint Cloud, MN 56303
Phone (320) 251-8385
400 10th St E
Waconia, MN 55387
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 156072 | MN | Yes |
Addresses
Primary practice location
5918 Crestwood CT
Saint Cloud, MN 56301-8850
Mailing address
5918 Crestwood CT
Saint Cloud, MN 56301-8850
Other providers in Saint Cloud, MN
- Amber Manders
- Kristen Manderschied
- Madeline Mangin
- Timothy Mangold
- Lara Jean Manikowski
- Mankato Home Health Care, LLC
- Kelly Manley
- Angelia Cynthia Marie Mann
- Michael Fuad Mansour
- Manuel R Moran
All providers in Saint Cloud, MN · Certified Registered Nurse Anesthetist in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 1, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.