black and white state seal

DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
BUREAU OF INSURANCE

SAMANTHA JO VAN THIEL

PRODUCER NON-RESIDENT

License Number:
PRN271744
Status:
First Licensure:
08/03/2016
Cancel Date:
None

Mailing:
LARSEN, WI 54947
Phone:
+1 (920) 521-2411 x2411
Fax:
+1 (920) 969-1727
Email:
svanthiel@jminsure.com

History

License Type Start Date End Date
PRODUCER NON-RESIDENT 08/03/2016

Agency

None.

Employer

Name Issue Date License Number Expiration Date Cancel Date
JEWELERS MUTUAL INSURANCE COMPANY, SI
08/04/2016 PCF773

Authority

Description Issue Date Termination Date Status
CASUALTY 08/03/2016 Active
PROPERTY 08/03/2016 Active

License/Disciplinary Action

None.

GENERAL INFORMATION

NAIC Information

National Producer Number (NPN):
18040435

Other Addresses

Address Type
JEWELERS MUTUAL INSURANCE COMPANY
24 JEWELERS PARK DR
NEENAH, WI 54956-3702
Office

An active license/permit may still be subject to limitations and restrictions as a result of disciplinary action imposed. Please contact the specific licensing board about specific disciplinary actions.

Date: 08/01/2026 04:41:50 AM