DEPARTMENT OF INSURANCE

Affiliations

Name	Susemichel, Laura Ann	DOIID	537152	NAIC NPN	7219353

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Inactive	Resident	Administrator	Not Applicable	9/5/2001	6/30/2005
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Provider Benefit Plans Inc.	401311	Administrator - Not Applicable	9/5/2001	6/30/2005