DEPARTMENT OF INSURANCE

DEPARTMENT OF INSURANCE

Affiliations

Name	Black, Dawn Marie	DOIID	952653	NAIC NPN	17174768

License - Line of Authority Information

Status	Residency	Class	Line of Authority	Active Date	Inactive Date	License Expiration Date
Active	Non Resident	Agent	Life	4/28/2017		11/30/2025
Active	Non Resident	Agent	Health	4/28/2017		11/30/2025
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.

Appointments with the following Insurers

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Aetna Health Inc. (PA)	660717	Agent - Health	12/22/2020	6/15/2023
Inactive	Aetna Life Insurance Company	301140	Agent - Health	12/22/2020	6/15/2023
Inactive	Freedom Life Insurance Company of America	300074	Agent - Health	5/11/2017	10/19/2023
Inactive	Freedom Life Insurance Company of America	300074	Agent - Life	5/11/2017	10/19/2023

Designated to act on behalf of the following Business Entities

Status	Affiliation Name	DOI Number	Line of Authority	Active Date	Inactive Date
Inactive	Ushealth Advisors Llc	713288	Agent - Life	5/11/2017	10/19/2023
Inactive	Ushealth Advisors Llc	713288	Agent - Health	5/11/2017	10/19/2023