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Details for Forman, Debra Nicole

Agent Details
Name
Forman, Debra Nicole 
Address
SELECTHEALTH 5381 GREEN STREET MURRAY, UT 84123 
Business Phone
(801) 442-9939 
Internet
 
Email
nicole.forman@selecthealth.org  
Status
Active 
Issue Date
Apr 27, 2004 
License Status Expires Number
Resident Producer Active Oct 31, 2022 213851
      Accident and Hlth or Sickness Active Issued: Aug 09, 2018
      Life Active Issued: Apr 27, 2004
      Accident & Health Inactive Issued: Apr 27, 2004
Resident Customer Service Rep Inactive Dec 31, 2004 197112
      Accident & Health Inactive Issued: Dec 24, 2002
      Life Inactive Issued: Dec 24, 2002
Agency Affiliations City State License Number Active Date Status
MCDERMOTT COMPANY & ASSOCIATES SOUTH JORDAN UT 4596 Jun 14, 2004 Active
MCDERMOTT COMPANY & ASSOCIATES SOUTH JORDAN UT 396593 Jun 14, 2004 Active
Company Affiliations City State Type Active Date
ACE AMERICAN INSURANCE COMPANY PHILADELPHIA PA Accident and Hlth or Sickness Aug 09, 2018
COMPANION LIFE INSURANCE COMPANY COLUMBIA SC Life Nov 07, 2016
COMPANION LIFE INSURANCE COMPANY COLUMBIA SC Accident and Hlth or Sickness Aug 09, 2018
EQUITABLE FINANCIAL LIFE INSURANCE COMPANY JERSEY CITY NJ Life Nov 21, 2005
SelectHealth Inc MURRAY UT Accident and Hlth or Sickness Aug 21, 2018
TOTAL DENTAL ADMINISTRATORS OF UTAH, INC SALT LAKE CITY UT Accident and Hlth or Sickness Aug 09, 2018